Provider Demographics
NPI:1508510553
Name:COX, STEPHANIE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:COX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:TUSTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 N HIATUS RD # 166
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1301
Mailing Address - Country:US
Mailing Address - Phone:757-271-4091
Mailing Address - Fax:757-295-8733
Practice Address - Street 1:11835 FISHING POINT DR STE 104
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-599-5588
Practice Address - Fax:757-599-6893
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily