Healthcare Provider Details

I. General information

NPI: 1760843809
Provider Name (Legal Business Name): STEFANIE TIBBITTS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14134 NEPHRON LN
HUDSON FL
34667-6504
US

IV. Provider business mailing address

14134 NEPHRON LN
HUDSON FL
34667-6504
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5418
  • Fax: 727-869-8626
Mailing address:
  • Phone: 727-863-5418
  • Fax: 727-869-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberARNP9217828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: