Healthcare Provider Details

I. General information

NPI: 1306407671
Provider Name (Legal Business Name): STEFANIE LYNN FOX CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7318 INTERNATIONAL DR STE E
HOLLAND OH
43528-9560
US

IV. Provider business mailing address

7318 INTERNATIONAL DR STE E
HOLLAND OH
43528-9560
US

V. Phone/Fax

Practice location:
  • Phone: 419-540-8930
  • Fax: 419-540-4160
Mailing address:
  • Phone: 419-540-8930
  • Fax: 419-540-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024997
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.024997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: