Healthcare Provider Details

I. General information

NPI: 1871128363
Provider Name (Legal Business Name): MARIA LANA STEVENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N HABANA AVE STE 703
TAMPA FL
33614-7122
US

IV. Provider business mailing address

379 6TH AVE W
BRADENTON FL
34205-8820
US

V. Phone/Fax

Practice location:
  • Phone: 813-678-2373
  • Fax: 833-449-5210
Mailing address:
  • Phone: 941-782-4150
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN1109653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: