Healthcare Provider Details

I. General information

NPI: 1336018753
Provider Name (Legal Business Name): HAILEY STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 OSPREY NEST LOOP APT 216
LUTZ FL
33559-3447
US

IV. Provider business mailing address

12901 BRUCE B DOWNS BLVD
TAMPA FL
33612-4742
US

V. Phone/Fax

Practice location:
  • Phone: 603-986-1326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9691979
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9691979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: