Provider Demographics
NPI:1619579075
Name:POLANIA, STEPHANIE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:POLANIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ARCHBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4269 N. PINE ISLAND RD.
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6044
Mailing Address - Country:US
Mailing Address - Phone:954-578-0200
Mailing Address - Fax:954-578-0050
Practice Address - Street 1:4269 N. PINE ISLAND RD.
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6044
Practice Address - Country:US
Practice Address - Phone:954-578-0200
Practice Address - Fax:954-578-0050
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine