Provider Demographics
NPI:1861812018
Name:MARTIN, STEPHANIE JOY FIESTA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE JOY
Middle Name:FIESTA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13421 FISHHAWK BLVD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3833
Practice Address - Country:US
Practice Address - Phone:813-844-8600
Practice Address - Fax:813-844-1145
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant