Provider Demographics
NPI:1043535396
Name:MEARS, STEPHEN TRACY (ARNP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:TRACY
Last Name:MEARS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 KELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2948
Mailing Address - Country:US
Mailing Address - Phone:850-482-2910
Mailing Address - Fax:850-482-2836
Practice Address - Street 1:4284 KELSON AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2948
Practice Address - Country:US
Practice Address - Phone:850-482-2910
Practice Address - Fax:850-482-2836
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218997363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB827ZOtherMEDICARE PTAN
FL1043535396-01OtherPRESTIGE
FL002110000Medicaid
FL1390773509OtherDOT REGISTRY
FLY03X8OtherBLUECROSS BLUESHIELD FLORIDA
FL941282OtherSTAYWELL/WELLCARE