MEDICARE: STEPHANIE MEYERS PA-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	363AS0400X	Surgical Physician Assistant	085004929	IL
2	363A00000X	Physician Assistant	PA9114392	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144642141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MEYERS PA-C

Provider Business Mailing Address
First Line	:	30115 STATE ROAD 52 STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576-8243
Country	:	US
Telephone Number	:	813-467-4244
Fax Number	:	813-467-4249

Provider Business Practice Location Address
First Line	:	30115 STATE ROAD 52 STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576-8243
Country	:	US
Telephone Number	:	813-467-4244
Fax Number	:	813-467-4249

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	10/20/2021

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