Healthcare Provider Details

I. General information

NPI: 1548794209
Provider Name (Legal Business Name): STEPHANIE STILLINGS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5913 WEBB RD
TAMPA FL
33615-3219
US

IV. Provider business mailing address

PO BOX 26026
TAMPA FL
33623-6026
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-8567
  • Fax: 813-875-0188
Mailing address:
  • Phone: 813-356-0196
  • Fax: 813-356-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME152965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: