MEDICARE: MS. STEPHANIE IRENE SPENCER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APRN11036676	FL

General Provider Information

NPI Number	:	1073325791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE IRENE SPENCER APRN

Provider Business Mailing Address
First Line	:	653 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-3334
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-0411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	02/17/2026

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