Provider Demographics
NPI:1376529503
Name:STEPHENS, DONNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 FIRST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8603
Mailing Address - Country:US
Mailing Address - Phone:727-321-9614
Mailing Address - Fax:727-323-7068
Practice Address - Street 1:2815 FIRST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8603
Practice Address - Country:US
Practice Address - Phone:727-321-9614
Practice Address - Fax:737-323-7068
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88883174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270509500Medicaid
FL40314ZMedicare PIN
FLI07445Medicare UPIN