MEDICARE: STEPHANIE L. MCCARRON

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	311ZA0620X	Adult Care Home Facility	6905760	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700205242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE L. MCCARRON

Provider Business Mailing Address
First Line	:	6163 MAPLEWOOD DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-4734
Country	:	US
Telephone Number	:	727-457-5668
Fax Number	:

Provider Business Practice Location Address
First Line	:	6163 MAPLEWOOD DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-4734
Country	:	US
Telephone Number	:	727-457-5668
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	03/31/2017

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