Healthcare Provider Details

I. General information

NPI: 1528133329
Provider Name (Legal Business Name): STEPHANIE ANN BLUBAUGH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN OWENS PA

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

1602 CASSIA CV
NICEVILLE FL
32578-3427
US

V. Phone/Fax

Practice location:
  • Phone: 850-885-1005
  • Fax:
Mailing address:
  • Phone: 850-499-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: