Healthcare Provider Details

I. General information

NPI: 1205495967
Provider Name (Legal Business Name): EMILY STEPHENSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 N DAVIS HWY
PENSACOLA FL
32514-6094
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-4700
  • Fax: 850-505-4711
Mailing address:
  • Phone: 904-697-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-186983
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11039465
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0000231396
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: