MEDICARE: DR. STEPHANIE TINE DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E5796	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4341	FL

General Provider Information

NPI Number	:	1326692781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE TINE DPM

Provider Business Mailing Address
First Line	:	3051 NE 41ST ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5801
Country	:	US
Telephone Number	:	954-594-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 N FEDERAL HWY STE 101
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4618
Country	:	US
Telephone Number	:	754-444-9258
Fax Number	:

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

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	01/21/2026

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Directions to “ DR. STEPHANIE TINE DPM” Practice Location

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