Healthcare Provider Details

I. General information

NPI: 1164026746
Provider Name (Legal Business Name): EILEEN M STEBBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14381 SPRING HILL DR
SPRING HILL FL
34609-8199
US

IV. Provider business mailing address

3257 GARDENIA DR
HERNANDO BEACH FL
34607-3506
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-0029
  • Fax:
Mailing address:
  • Phone: 954-558-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: