Healthcare Provider Details

I. General information

NPI: 1629266796
Provider Name (Legal Business Name): S T E P H INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 SW 19TH ST
FORT LAUDERDALE FL
33315-2049
US

IV. Provider business mailing address

609 SW 19TH ST
FORT LAUDERDALE FL
33315-2049
US

V. Phone/Fax

Practice location:
  • Phone: 754-581-2844
  • Fax: 954-463-0457
Mailing address:
  • Phone: 754-581-2844
  • Fax: 954-463-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP 9191721
License Number StateFL

VIII. Authorized Official

Name: MS. STEPHANIE H. FORD
Title or Position: PRESIDENT/OWNER
Credential: ARNP
Phone: 754-581-2844