Healthcare Provider Details

I. General information

NPI: 1952736688
Provider Name (Legal Business Name): STEPHANIE WOODBURN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW 49TH AVE 101
LAUDERDALE LAKES FL
33313-1600
US

IV. Provider business mailing address

2951 NW 49 AVE 101
LAUDERDALE LAKES FL
33313
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-2511
  • Fax: 954-739-9239
Mailing address:
  • Phone: 954-739-2511
  • Fax: 954-739-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2852742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: