Provider Demographics
NPI:1821154287
Name:MCDONALD, STEPHEN JAMES (ARNP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31606 BUGLE LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4756
Mailing Address - Country:US
Mailing Address - Phone:813-782-6285
Mailing Address - Fax:
Practice Address - Street 1:3102 E 138TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-615-7840
Practice Address - Fax:813-615-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2200212363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS99108Medicare UPIN