MEDICARE: MS. STEPHANIE ANNE PENG CAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5280	FL
2	101YM0800X	Mental Health Counselor	8995	FL

General Provider Information

NPI Number	:	1417202045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ANNE PENG CAP

Provider Business Mailing Address
First Line	:	5501 W WATERS AVE STE 404
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1229
Country	:	US
Telephone Number	:	813-881-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 W WATERS AVE STE 404
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1229
Country	:	US
Telephone Number	:	813-881-1000
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	03/01/2013

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