| NPI | 1063407930 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2005-09-15 |
| Last Updated | 2025-12-03 |
| Mailing Address | Po Box 2147 Fort Myers, FL 33902-2147 United States Phone: (239) 541-7500 | Fax: (239) 541-7501 📍 View Map |
| Primary Practice Address | 4771 S Cleveland Ave Fort Myers, FL 33907-1317 United States Phone: (239) 343-9800 | Fax: (239) 343-9848 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | FL | 108406800 | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 363AM0700X – Physician Assistant, Medical | WI | 608023 |
| Yes | 363A00000X – Physician Assistant | FL | PA9113677 |
| No | 363A00000X – Physician Assistant | — | — |
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About NPI 1063407930
Kristin J Ovadal PAC is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1063407930. The primary specialty listed is Physician Assistant. The provider is located in Fort Myers, FL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2005-09-15. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1063407930?
NPI 1063407930 belongs to Kristin J Ovadal PAC, a Physician Assistant in Fort Myers, FL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1063407930 active?
The current status of NPI 1063407930 in the NPPES registry is Active. The record was last updated on 2025-12-03.
What specialty is NPI 1063407930?
NPI 1063407930 is classified under the taxonomy Physician Assistant. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1063407930?
You can verify NPI 1063407930 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1063407930?
The primary practice address on file for NPI 1063407930 is 4771 S Cleveland Ave, Fort Myers, FL 33907-1317. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1063407930 issued?
NPI 1063407930 was first issued (enumerated) on 2005-09-15. The NPPES record was last updated on 2025-12-03.
Practice Location Map
Kristin J Ovadal is located at 4771 S Cleveland Ave, Fort Myers, FL. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Kristin J Ovadal. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1063407930. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Physician Assistant, Medical | 608023 | WI |
| Physician Assistant | PA9113677 | FL |