Provider Demographics
NPI:1922140094
Name:LEVIYEVA, STELLA (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:STELLA
Middle Name:
Last Name:LEVIYEVA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2874
Mailing Address - Country:US
Mailing Address - Phone:954-559-8699
Mailing Address - Fax:
Practice Address - Street 1:2201 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2874
Practice Address - Country:US
Practice Address - Phone:954-559-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3029592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL312107100Medicaid