Healthcare Provider Details

I. General information

NPI: 1144825498
Provider Name (Legal Business Name): BARBARA JANINE STEVENSON CRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 US HIGHWAY 27 N STE 60
SEBRING FL
33870-2129
US

IV. Provider business mailing address

718 OAK FOREST DR
WAUCHULA FL
33873-3070
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-1176
  • Fax:
Mailing address:
  • Phone: 863-245-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: