Healthcare Provider Details

I. General information

NPI: 1770536245
Provider Name (Legal Business Name): LUCY M STEPHEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12973 N TELECOM PKWY SUITE 100
TEMPLE TERRACE FL
33637-0907
US

IV. Provider business mailing address

12973 N TELECOM PKWY SUITE 100
TEMPLE TERRACE FL
33637-0907
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-8111
  • Fax: 813-383-5044
Mailing address:
  • Phone: 813-871-8111
  • Fax: 813-383-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2019342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: