Healthcare Provider Details

I. General information

NPI: 1114712056
Provider Name (Legal Business Name): STEPHANY CARMONA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 TOWN LOOP BLVD STE 204
ORLANDO FL
32837-6190
US

IV. Provider business mailing address

13683 TYBEE BEACH LANE
ORLANDO FL
32827-4924
US

V. Phone/Fax

Practice location:
  • Phone: 407-251-8800
  • Fax:
Mailing address:
  • Phone: 321-746-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9120020
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9120020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: