Provider Demographics
NPI:1861613663
Name:KUHARIC STEPHENS, TEA (MD)
Entity type:Individual
Prefix:DR
First Name:TEA
Middle Name:
Last Name:KUHARIC STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4320 DEERWOOD LAKE PKWY
Mailing Address - Street 2:STE 101 PMB 321
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1177
Mailing Address - Country:US
Mailing Address - Phone:904-371-4051
Mailing Address - Fax:888-745-5445
Practice Address - Street 1:3840 BELFORT RD
Practice Address - Street 2:#102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8207
Practice Address - Country:US
Practice Address - Phone:904-371-4051
Practice Address - Fax:888-745-5445
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME97374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV024ZMedicare PIN