Individual
STEPHANIE A LAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2780 CLEVELAND AVE, SUITE 819, FORT MYERS, FL 33901-5858
(239) 343-3800
(239) 343-3993
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1400
(239) 424-1421
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9102148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9102148
LICENSE
FL
Enumeration date
10/27/2005
Last updated
08/14/2013
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