Provider Demographics
NPI:1124210067
Name:INGRAM, STEPHANIE FERNICE (MD,)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FERNICE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-547-2373
Mailing Address - Fax:352-416-1813
Practice Address - Street 1:3304 SW 34TH CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3358
Practice Address - Country:US
Practice Address - Phone:352-291-0245
Practice Address - Fax:352-291-0231
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME106910207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN071ZMedicare PIN