Healthcare Provider Details

I. General information

NPI: 1194586966
Provider Name (Legal Business Name): MARIA BETANIA STEVENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 S SEACREST BLVD STE 600W
BOYNTON BEACH FL
33435-7501
US

IV. Provider business mailing address

PO BOX 743144
ATLANTA GA
30374-3144
US

V. Phone/Fax

Practice location:
  • Phone: 561-336-7700
  • Fax:
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11030589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: