Provider Demographics
NPI:1578504163
Name:STEPHENS, PAMELA A (CNM ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E KENNEDY BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3511
Mailing Address - Country:US
Mailing Address - Phone:813-307-8015
Mailing Address - Fax:813-276-2999
Practice Address - Street 1:1105 E KENNEDY BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3511
Practice Address - Country:US
Practice Address - Phone:813-307-8015
Practice Address - Fax:813-276-2999
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1079232367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301546700Medicaid
FLS20206Medicare UPIN
FL301546700Medicaid