Healthcare Provider Details

I. General information

NPI: 1821154287
Provider Name (Legal Business Name): STEPHEN JAMES MCDONALD ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E 138TH AVE
TAMPA FL
33613
US

IV. Provider business mailing address

31606 BUGLE LN
WESLEY CHAPEL FL
33543-4756
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7840
  • Fax: 813-615-7711
Mailing address:
  • Phone: 813-782-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number2200212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: