Provider Demographics
NPI:1518252501
Name:CARSTENS, STEPHANIE JO (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:CARSTENS
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 1:915 W. MONROE STREET
Mailing Address - Street 2:S. 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-903-4345
Mailing Address - Fax:573-884-8142
Practice Address - Street 1:915 W. MONROE STREET
Practice Address - Street 2:S. 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-903-4345
Practice Address - Fax:573-884-8142
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122859207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014939100Medicaid
FLIF044ZMedicare PIN