Provider Demographics
NPI:1689139297
Name:STEVANUS, AUTUMN NICOLE (MSN, APRN, A-GNP-C)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
Last Name:STEVANUS
Suffix:
Gender:F
Credentials:MSN, APRN, A-GNP-C
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:NICOLE
Other - Last Name:BRUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1954 FIESTA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7700
Mailing Address - Country:US
Mailing Address - Phone:727-560-0471
Mailing Address - Fax:
Practice Address - Street 1:8614 STATE ROAD 70 E STE 104
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-216-3800
Practice Address - Fax:941-216-3703
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9310880363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology