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General NPI Number Information
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NPI Number | 1689139297
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Entity Type | Individual
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Provider Name | AUTUMN NICOLE STEVANUS MSN, APRN, A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 8614 STATE ROAD 70 E STE 104
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City | BRADENTON
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State | FL
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Zip | 34202-3710
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Country | US
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Telephone | 941-216-3800
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Fax | 941-216-3703
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Provider Business Mailing Address
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Address Line | 1954 FIESTA RIDGE CT
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City | TAMPA
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State | FL
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Zip | 33604-7700
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Country | US
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Telephone | 727-560-0471
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN9310880
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN9310880
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License Number State | FL
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