MEDICARE: STEPHANIE LOCKETT M.D.

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	2084P0800X	Psychiatry Physician	L4063	TX
2	2084P0800X	Psychiatry Physician	ME100649	FL

General Provider Information

NPI Number	:	1629032073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LOCKETT M.D.

Provider Business Mailing Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:	813-272-2244
Fax Number	:	813-272-3766

Provider Business Practice Location Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:	813-272-2244
Fax Number	:	813-272-3766

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/23/2016

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Directions to “ STEPHANIE LOCKETT M.D.” Practice Location

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