Healthcare Provider Details

I. General information

NPI: 1043718521
Provider Name (Legal Business Name): JILLIAN AUDREYA FAWN STUPER DNP, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JILLIAN AUDREYA FAWN STRAHAN I

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 ROWAN RD
NEW PORT RICHEY FL
34653-3400
US

IV. Provider business mailing address

6322 ROWAN RD
NEW PORT RICHEY FL
34653-3400
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-9355
  • Fax:
Mailing address:
  • Phone: 727-777-9355
  • Fax: 800-339-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9344892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: