Individual provider Active NPI

Harleigh Plachetka

  • Medical Physician Assistant
  • Lehigh Acres, FL
National Provider Identifier
1669208773
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
3507 Lee Blvd Ste 107
Lehigh Acres, FL 33971-1303
Phone
(239) 368-8071
Fax
(239) 368-8074
NPI assigned
Sep 13, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 9119530 FL
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

3507 Lee Blvd Ste 107
Lehigh Acres, FL 33971-1303

Mailing address

24911 Surf Haven LN
Bonita Springs, FL 34135-7357
Phone (920) 257-9828

Other practice location 1

8800 Bernwood Pkwy Ste 6
Bonita Springs, FL 34135-9527
Phone (239) 464-1433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241227001187 FL Practitioner - Physician Assistant 5294262580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovative Dermatology and Mohs Surgery LLCGroup PAC ID 7416268255, 3 clinicians

Practice addresses (Care Compare)

3507 Lee Blvd
Suite 107
Lehigh Acres, FL 33971-1303
Phone (239) 368-8071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9119530FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Dermatology and Mohs Surgery LLC CurrentSince Mar 2, 2026 Accepting new patients

Locations

8800 Bernwood Pkwy
Ste 6
Bonita Springs, FL 34135
Phone (239) 464-1433

3507 Lee Blvd
Ste 107
Lehigh Acres, FL 33971
Phone (239) 303-2328

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1669208773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24911 SURF HAVEN LN",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341357357",
            "telephone_number": "920-257-9828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3507 LEE BLVD STE 107",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711303",
            "telephone_number": "239-368-8071",
            "fax_number": "239-368-8074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 Bernwood Pkwy Ste 6",
            "address_purpose": "LOCATION",
            "city": "Bonita Springs",
            "state": "FL",
            "postal_code": "341359527",
            "country_code": "US",
            "telephone_number": "239-464-1433",
            "fax_number": "239-368-8074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLACHETKA",
        "first_name": "HARLEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-13",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9119530",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

Verify at the official NPI Registry.