Healthcare Provider Details

I. General information

NPI: 1982911046
Provider Name (Legal Business Name): STEDVEN LIEBEN KAI FELICIANO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 AIRPORT BLVD STE B
PENSACOLA FL
32504-8649
US

IV. Provider business mailing address

1110 AIRPORT BLVD STE B
PENSACOLA FL
32504-8649
US

V. Phone/Fax

Practice location:
  • Phone: 850-438-1136
  • Fax:
Mailing address:
  • Phone: 850-438-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9119789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: