Healthcare Provider Details

I. General information

NPI: 1861613663
Provider Name (Legal Business Name): TEA KUHARIC STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/22/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 BELFORT RD #102
JACKSONVILLE FL
32216-8207
US

IV. Provider business mailing address

4320 DEERWOOD LAKE PKWY STE 101 PMB 321
JACKSONVILLE FL
32216-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-371-4051
  • Fax: 888-745-5445
Mailing address:
  • Phone: 904-371-4051
  • Fax: 888-745-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME97374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: