MEDICARE: MRS. STEPHANIE MENDOZA CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1211524	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1831899467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE MENDOZA CRNA

Provider Business Mailing Address
First Line	:	4159 AFTON CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7820
Country	:	US
Telephone Number	:	561-225-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	4159 AFTON CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7820
Country	:	US
Telephone Number	:	561-225-9229
Fax Number	:

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	09/24/2025

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