Provider Demographics
NPI:1477927390
Name:GEORGOUDIOU, STEPHANIE (ARNP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:GEORGOUDIOU
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 1:5939 HARRY HINES BLVD SUITE HA3.104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9333
Mailing Address - Country:US
Mailing Address - Phone:214-645-7900
Mailing Address - Fax:214-645-4497
Practice Address - Street 1:5939 HARRY HINES BLVD SUITE HA3.104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-645-7900
Practice Address - Fax:214-645-4497
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9251267363L00000X
TXAP132419363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner