Healthcare Provider Details

I. General information

NPI: 1215360656
Provider Name (Legal Business Name): STEVEN LEWIS GROWCOCK SR. ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 772-475-4887
  • Fax:
Mailing address:
  • Phone: 772-475-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9304160
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9304160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: