Provider Demographics
NPI:1073325791
Name:SPENCER, STEPHANIE IRENE (APRN)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:IRENE
Last Name:SPENCER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:2415 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-466-7681
Mailing Address - Fax:912-264-2788
Practice Address - Street 1:2415 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4722
Practice Address - Country:US
Practice Address - Phone:912-466-7681
Practice Address - Fax:912-264-2788
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036676207RC0200X
GARN284669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine