Provider Demographics
NPI:1659650620
Name:FERRER, STEPHANIE L (MMSPA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FERRER
Suffix:
Gender:F
Credentials:MMSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 S CONGRESS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4761
Mailing Address - Country:US
Mailing Address - Phone:561-548-8600
Mailing Address - Fax:561-548-8650
Practice Address - Street 1:4685 S CONGRESS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4761
Practice Address - Country:US
Practice Address - Phone:561-548-8600
Practice Address - Fax:561-548-8650
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106249363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014154100Medicaid
FLFT671XMedicare PIN