Basic Information
Provider Information
NPI: 1003016932
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEPHAN
FirstName: LINDA
MiddleName: JEAN
NamePrefix: MS.
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6450 38TH AVE N
Address2: SUITE 200
City: SAINT PETERSBURG
State: FL
PostalCode: 33710
CountryCode: US
TelephoneNumber: 7273446060
FaxNumber: 7273475586
Practice Location
Address1: 6450 38TH AVE N
Address2: SUITE 200
City: SAINT PETERSBURG
State: FL
PostalCode: 33710
CountryCode: US
TelephoneNumber: 7273446060
FaxNumber: 7273475586
Other Information
ProviderEnumerationDate: 07/19/2007
LastUpdateDate: 03/02/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
176B00000X25ME00044401NJN Other Service ProvidersMidwife 
363LX0001XARNP9289046FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
367A00000XARNP9289046FLY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
25ME0004440101NJCNM LICENSEOTHER
ARNP928904601FLBOARD OF NURSING LICENSEOTHER


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