Healthcare Provider Details

I. General information

NPI: 1821356460
Provider Name (Legal Business Name): STEPHANIE ERWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 SAINT JOHNS AVE SUITE 3
JACKSONVILLE FL
32210-1848
US

IV. Provider business mailing address

4570 SAINT JOHNS AVE SUITE 3
JACKSONVILLE FL
32210-1848
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-5231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: