Healthcare Provider Details

I. General information

NPI: 1043718521
Provider Name (Legal Business Name): JILLIAN AUDREYA FAWN STUPER DNP, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JILLIAN AUDREYA FAWN STRAHAN

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21705 BOWMAN RD
SPRING HILL FL
34610
US

IV. Provider business mailing address

14405 BIRCH ST
HUDSON FL
34667-1172
US

V. Phone/Fax

Practice location:
  • Phone: 727-364-4393
  • Fax:
Mailing address:
  • Phone: 727-364-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9344892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: