Provider Demographics
NPI:1134425028
Name:JOY, STEPHANIE ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:JOY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1801 COX NECK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2311
Mailing Address - Country:US
Mailing Address - Phone:410-604-0178
Mailing Address - Fax:
Practice Address - Street 1:2007 TIDEWATER COLONY DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2101
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:443-949-0825
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR177898OtherLICENSE