MEDICARE: DR. CAROL W STEPHENSON CLAYTON DNS, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP1990612	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
2	380124	OTHER	FL	WELLCARE
3	01134624	OTHER	FL	AMERIGROUP

General Provider Information

NPI Number	:	1356300347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL W STEPHENSON CLAYTON DNS, CPNP

Provider Business Mailing Address
First Line	:	110 S WOODLAND ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3546
Country	:	US
Telephone Number	:	407-905-8827
Fax Number	:	407-905-8998

Provider Business Practice Location Address
First Line	:	618 S FOREST AVE
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5338
Country	:	US
Telephone Number	:	407-905-8827
Fax Number	:	407-886-3822

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	08/27/2020

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