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General NPI Number Information
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NPI Number | 1114433166
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Entity Type | Individual
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Provider Name | STEPHANIE E HATTAWAY ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 4929 MOBILE HWY
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City | PENSACOLA
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State | FL
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Zip | 32506
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Country | US
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Telephone | 850-530-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 4015
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3623
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Country | US
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Telephone | 850-453-3281
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Fax |
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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 | 9268128
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License Number State | FL
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