Healthcare Provider Details

I. General information

NPI: 1376128116
Provider Name (Legal Business Name): STEPHANIE MARIAN TABONE CNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S LAKELINE BLVD STE 100
CEDAR PARK TX
78613-2968
US

IV. Provider business mailing address

5406 MCCANDLESS ST
AUSTIN TX
78756-2213
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-8970
  • Fax: 855-220-9655
Mailing address:
  • Phone: 512-797-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141570
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: