Provider Demographics
NPI:1548220239
Name:STEVENS, WENDY H (PA-C)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:H
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1697 KINGS RD
Practice Address - Street 2:UFJP COLLEGE PARK FAMILY PRACTICE CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6169
Practice Address - Country:US
Practice Address - Phone:904-389-2251
Practice Address - Fax:904-353-4479
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-08-27
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Provider Licenses
StateLicense IDTaxonomies
FLPA3398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2920361-00Medicaid
FLE5022YMedicare PIN
FL970024507Medicare PIN
FL2920361-00Medicaid