Provider Demographics
NPI:1356779128
Name:MILFORD, STEPHANIE (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MILFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 GOLDENROD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5120
Mailing Address - Country:US
Mailing Address - Phone:248-763-4444
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVENUE
Practice Address - Street 2:SUITE 308
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3023
Practice Address - Fax:248-858-3022
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759439163W00000X
FL11004809367500000X
MI4704272076163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse