Healthcare Provider Details

I. General information

NPI: 1003807371
Provider Name (Legal Business Name): STEPHANI C LOWERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4467
US

IV. Provider business mailing address

PO BOX 100286
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0761
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax: 352-265-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017139339
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11021670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: