Healthcare Provider Details

I. General information

NPI: 1477940641
Provider Name (Legal Business Name): STEPHANIE HOATSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W MICHIGAN ST STE 118
ORLANDO FL
32806-4465
US

IV. Provider business mailing address

160 BOSTON AVE
ALTAMONTE SPRINGS FL
32701-4706
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-0324
  • Fax: 407-896-2488
Mailing address:
  • Phone: 407-775-7654
  • Fax: 407-834-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME139901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: