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General NPI Number Information
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NPI Number | 1104277649
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Entity Type | Individual
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Provider Name | STEPHEN T MAYNARD ARNP
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Gender | Male
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 4675 28TH CT
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City | VERO BEACH
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State | FL
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Zip | 32967-1329
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Country | US
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Telephone | 772-257-8224
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Fax | 772-252-3245
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Provider Business Mailing Address
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Address Line | 1555 INDIAN RIVER BLVD STE B210
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City | VERO BEACH
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State | FL
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Zip | 32960-7113
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Country | US
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Telephone | 772-257-8224
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Fax | 772-252-3245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.020458
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License Number State | OH
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