=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922280460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. KARIN KAE STANTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2154 DUCK SLOUGH BLVD STE 103
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-264-7655
-----------------------------------------------------
Fax | 727-264-7735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2154 DUCK SLOUGH BLVD STE 103
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-264-7655
-----------------------------------------------------
Fax | 727-264-7735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | OS10472
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 5315019245
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | OS10472
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------