Healthcare Provider Details

I. General information

NPI: 1992741664
Provider Name (Legal Business Name): STEPHEN TOMICICH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 MEDICAL DR
TALLAHASSEE FL
32308-4615
US

IV. Provider business mailing address

1541 MEDICAL DR
TALLAHASSEE FL
32308-4615
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-7801
  • Fax: 850-431-7809
Mailing address:
  • Phone: 850-431-7801
  • Fax: 850-431-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3294412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: