Provider Demographics
NPI:1770536245
Name:STEPHEN, LUCY M (ARNP)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:STEPHEN
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 1:12973 N TELECOM PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0907
Mailing Address - Country:US
Mailing Address - Phone:813-871-8111
Mailing Address - Fax:813-383-5044
Practice Address - Street 1:12973 N TELECOM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0907
Practice Address - Country:US
Practice Address - Phone:813-871-8111
Practice Address - Fax:813-383-5044
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2019342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2019342OtherARNP LICENSE
FLP70775Medicare UPIN