Healthcare Provider Details

I. General information

NPI: 1013065408
Provider Name (Legal Business Name): STEPHANIE PAILLANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10944 SW 138TH CT
MIAMI FL
33186
US

IV. Provider business mailing address

1640 NE 37TH AVE
HOMESTEAD FL
33033-5668
US

V. Phone/Fax

Practice location:
  • Phone: 617-308-1973
  • Fax:
Mailing address:
  • Phone: 617-308-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9360447
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number67572
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: