MEDICARE: STEFANIE OUWERKERK

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	133V00000X	Registered Dietitian	DT87463	TX
2	133V00000X	Registered Dietitian	ND10899	FL

General Provider Information

NPI Number	:	1144163692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE OUWERKERK

Provider Business Mailing Address
First Line	:	11070 LIPPIZAN DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1231
Country	:	US
Telephone Number	:	516-815-7963
Fax Number	:

Provider Business Practice Location Address
First Line	:	11070 LIPPIZAN DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1231
Country	:	US
Telephone Number	:	516-815-7963
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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Directions to “ STEFANIE OUWERKERK ” Practice Location

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