Provider Demographics
NPI:1265168835
Name:MCQUILLAN, STEPHANIE MARCENE (APRN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARCENE
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19817 WYNDHAM LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1726
Mailing Address - Country:US
Mailing Address - Phone:727-543-5178
Mailing Address - Fax:
Practice Address - Street 1:19817 WYNDHAM LAKES DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1726
Practice Address - Country:US
Practice Address - Phone:727-543-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily