Provider Demographics
NPI:1831759141
Name:FORDE, STEPHANIE R
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:FORDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STEPHANIE GREEN
Mailing Address - Street 1:12379 GLIMMER WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-1867
Mailing Address - Country:US
Mailing Address - Phone:904-314-7411
Mailing Address - Fax:904-751-2200
Practice Address - Street 1:12379 GLIMMER WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-1867
Practice Address - Country:US
Practice Address - Phone:904-314-7411
Practice Address - Fax:904-751-2200
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child