MEDICARE: INGRID STEWART

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	363LP2300X	Primary Care Nurse Practitioner	2063152	FL

General Provider Information

NPI Number	:	1538670021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID STEWART

Provider Business Mailing Address
First Line	:	PO BOX 681282
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32868-1282
Country	:	US
Telephone Number	:	407-860-7261
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 WATCH HILL CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2029
Country	:	US
Telephone Number	:	407-860-7261
Fax Number	:	407-860-7261

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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Directions to “ INGRID STEWART ” Practice Location

Language	Start Address	Practice Location

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