Healthcare Provider Details

I. General information

NPI: 1891183158
Provider Name (Legal Business Name): SARA MARIE STEVENS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA MARIE IPPOLITO

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2043 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7000
  • Fax:
Mailing address:
  • Phone: 727-846-7000
  • Fax: 727-440-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704296597
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704296597
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11002398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: