Provider Demographics
NPI:1093854895
Name:STEVENS, MARY JAYCOX (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JAYCOX
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5615
Mailing Address - Country:US
Mailing Address - Phone:813-334-8543
Mailing Address - Fax:813-891-6931
Practice Address - Street 1:6350 76TH AVE NORTH
Practice Address - Street 2:CLINIC SUITE
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33761-3152
Practice Address - Country:US
Practice Address - Phone:727-547-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1980363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical