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General NPI Number Information
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NPI Number | 1285188219
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Entity Type | Individual
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Provider Name | STEFANIE MARIE INDELLICATI PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 603 7TH ST S SUITE 360
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-553-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 TRIMARAN PL
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City | TAMPA
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State | FL
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Zip | 33607-5837
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Country | US
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Telephone | 352-812-0102
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAT 9109630
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License Number State | FL
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