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General NPI Number Information
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NPI Number | 1902647415
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Entity Type | Individual
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Provider Name | STEPHANIE RESURRECCION
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 2875 NE 191ST ST STE 500
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City | AVENTURA
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State | FL
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Zip | 33180-2832
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Country | US
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Telephone | 443-383-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 2273 CLUB LAKE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2650
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Country | US
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Telephone | 904-333-2065
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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 | 11033194
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License Number State | FL
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