1336610856 NPI number — MRS. OLIVIA LAUREL STOLZ PA-C

Table of content: MRS. OLIVIA LAUREL STOLZ PA-C (NPI 1336610856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336610856 NPI number — MRS. OLIVIA LAUREL STOLZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLZ
Provider First Name:
OLIVIA
Provider Middle Name:
LAUREL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEISS
Provider Other First Name:
OLIVIA
Provider Other Middle Name:
LAUREL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336610856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 E FOWLER AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33617-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-978-9700
Provider Business Mailing Address Fax Number:
813-558-6185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 W PLYMOUH AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-978-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  9111738 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 9111738 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109284300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com