Healthcare Provider Details

I. General information

NPI: 1689898348
Provider Name (Legal Business Name): STEVEN MARK FOUNTAIN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 TINSMITH CIR
LUTZ FL
33559-3372
US

IV. Provider business mailing address

1778 TINSMITH CIR
LUTZ FL
33559-3369
US

V. Phone/Fax

Practice location:
  • Phone: 813-375-2120
  • Fax: 813-803-3362
Mailing address:
  • Phone: 813-375-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9329413
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9329413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: