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General NPI Number Information
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NPI Number | 1447251830
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE PENNY P.A.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 13575 NW 1ST LN STE 10
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City | NEWBERRY
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State | FL
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Zip | 32669-3735
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Country | US
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Telephone | 352-559-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 13575 NW 1ST LN STE 10
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City | NEWBERRY
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State | FL
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Zip | 32669-3735
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Country | US
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Telephone | 352-260-0170
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1642
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101259
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License Number State | FL
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