Provider Demographics
NPI:1134174600
Name:FLOOD, STEPHANIE M (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:FLOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:F
Other - Last Name:WEIMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:MS
Mailing Address - Zip Code:39555-0974
Mailing Address - Country:US
Mailing Address - Phone:321-222-9287
Mailing Address - Fax:830-255-5842
Practice Address - Street 1:7901 4TH STREET N, STE 300
Practice Address - Street 2:REGISTERED AGENTS INC FOR PHOENIX VIRTUAL TELEHEALTH
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:321-222-9287
Practice Address - Fax:830-255-5842
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P10582Medicare UPIN