Healthcare Provider Details

I. General information

NPI: 1912511429
Provider Name (Legal Business Name): STEPHANIE NICOLE BUNCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD
MIAMI FL
33132-1449
US

IV. Provider business mailing address

9727 SAGE CREEK DR
SUN CITY CENTER FL
33573-6684
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-0323
  • Fax: 866-427-3798
Mailing address:
  • Phone: 813-810-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11008670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: