MEDICARE: STEPHANIE K FENNEMA PA-C

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	363A00000X	Physician Assistant	PAT 9103434	FL
2	363A00000X	Physician Assistant	005416	GA
3	363A00000X	Physician Assistant	3168	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	U6631	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1194751792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE K FENNEMA PA-C

Provider Business Mailing Address
First Line	:	4106 COLUMBIA ROAD
Second Line	:	SUITE 103
City	:	MARTINEZ
State	:	GA
Zip	:	30907
Country	:	US
Telephone Number	:	706-863-1440
Fax Number	:	706-863-5418

Provider Business Practice Location Address
First Line	:	3813 OLD PORT ROYAL RD N
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2813
Country	:	US
Telephone Number	:	931-487-1006
Fax Number	:

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	02/11/2025

Similar Medicare Providers

1134452865 — FAST PACE MEDICAL CLINIC PLLC
Practice Location Address:

3813 OLD PORT ROYAL RD N
SPRING HILL, TN
37174-2813

Practice Phone: 931-487-1006
Practice Fax:

1063255651 — FAST PACE MEDICAL CLINIC PLLC
Practice Location Address:

3813 OLD PORT ROYAL RD N
SPRING HILL, TN
37174-2813

Practice Phone: 931-487-1006
Practice Fax:

1053515999 — YOLANDA CESILA KANANEN AUDIOPROSTHOLOGIST
Practice Location Address:

425 GREGORY LN STE 202
PLEASANT HILL, CA
94523-2813

Practice Phone: 925-674-8621
Practice Fax: 925-674-0874

1578790820 — POSITIVE APPROACH CONSULTANTS, INC.
Practice Location Address:

2813 TURKEY HILL TRL
TALLAHASSEE, FL
32312-3741

Practice Phone: 850-524-1368
Practice Fax: 850-524-1368

1841427093 — DR. EMMA DE LA CARIDAD GUILARTE
Practice Location Address:

2813 TURKEY HILL TRL
TALLAHASSEE, FL
32312-3741

Practice Phone: 850-524-1368
Practice Fax:

1801169362 — ADVANCED HEARING AID CENTER
Practice Location Address:

425 GREGORY LN STE 202
PLEASANT HILL, CA
94523-2813

Practice Phone: 925-674-8621
Practice Fax: 925-674-0874

Directions to “ STEPHANIE K FENNEMA PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.