Provider Demographics
NPI:1356519417
Name:STOVERINK, JOANNA ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:ELIZABETH
Last Name:STOVERINK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:ELIZABETH
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-3262
Mailing Address - Fax:904-265-4807
Practice Address - Street 1:3635 S CLYDE MORRIS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2300
Practice Address - Country:US
Practice Address - Phone:386-788-1242
Practice Address - Fax:386-756-8802
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ161YMedicare PIN