Basic Information
| Provider Information | |||||||||
| NPI: | 1003016932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHAN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 25ME00044401 | NJ | N | Other Service Providers | Midwife | 363LX0001X | ARNP9289046 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | ARNP9289046 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | ARNP9289046 | 01 | FL | BOARD OF NURSING LICENSE | OTHER | 25ME00044401 | 01 | NJ | CNM LICENSE | OTHER |