Provider Demographics
NPI:1144642141
Name:MEYERS, STEPHANIE (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30115 STATE ROAD 52 STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-8243
Mailing Address - Country:US
Mailing Address - Phone:813-467-4244
Mailing Address - Fax:813-467-4249
Practice Address - Street 1:30115 STATE ROAD 52 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-8243
Practice Address - Country:US
Practice Address - Phone:813-467-4244
Practice Address - Fax:813-467-4249
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004929363AS0400X
FLPA9114392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicare PIN