Provider Demographics
NPI:1760262257
Name:FORD, STEPHANIE THERESA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:THERESA
Last Name:FORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2617
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:844-470-2777
Practice Address - Street 1:9920 S RURAL RD # A108
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4100
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:844-470-2777
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ298268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204158Medicaid