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General NPI Number Information
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NPI Number | 1326927377
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Entity Type | Individual
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Provider Name | STEPHANIE FONTANA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1850 SAM RITTENBERG BLVD STE B
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City | CHARLESTON
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State | SC
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Zip | 29407-4936
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Country | US
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Telephone | 843-793-6093
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Fax |
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Provider Business Mailing Address
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Address Line | 234 WALNUT GROVE COURT
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City | MYRTLE BEACH
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State | SC
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Zip | 29577
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Country | US
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Telephone | 203-444-1503
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 30876
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License Number State | SC
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