MEDICARE: MRS. MARY JAYCOX STEVENS P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA1980	FL

General Provider Information

NPI Number	:	1093854895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JAYCOX STEVENS P.A.-C

Provider Business Mailing Address
First Line	:	3809 SHORE BLVD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-5615
Country	:	US
Telephone Number	:	813-334-8543
Fax Number	:	813-891-6931

Provider Business Practice Location Address
First Line	:	6350 76TH AVE NORTH
Second Line	:	CLINIC SUITE
City	:	PINELLAS PARK
State	:	FL
Zip	:	33761-3152
Country	:	US
Telephone Number	:	727-547-7780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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