Provider Demographics
NPI:1578728069
Name:STEPHENS, PATRICIA NICOLE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:NICOLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20915 REGISTER RD
Mailing Address - Street 2:
Mailing Address - City:TRILBY
Mailing Address - State:FL
Mailing Address - Zip Code:33593
Mailing Address - Country:US
Mailing Address - Phone:352-583-3490
Mailing Address - Fax:
Practice Address - Street 1:20915 REGISTER ROAD
Practice Address - Street 2:
Practice Address - City:TRILBY
Practice Address - State:FL
Practice Address - Zip Code:33593
Practice Address - Country:US
Practice Address - Phone:352-583-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL350101060359926183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician