Healthcare Provider Details

I. General information

NPI: 1144853557
Provider Name (Legal Business Name): STEPHANIE ELAINE DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 PARK BLVD N
PINELLAS PARK FL
33781-3714
US

IV. Provider business mailing address

2115 CENTRAL AVE
ST PETERSBURG FL
33713-8815
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-5437
  • Fax:
Mailing address:
  • Phone: 727-526-9135
  • Fax: 727-526-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11001669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: