Provider Demographics
NPI:1114712056
Name:CARMONA, STEPHANY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANY
Middle Name:
Last Name:CARMONA
Suffix:
Gender:
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 1:13683 TYBEE BEACH LANE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-4924
Mailing Address - Country:US
Mailing Address - Phone:321-746-3795
Mailing Address - Fax:
Practice Address - Street 1:14050 TOWN LOOP BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6190
Practice Address - Country:US
Practice Address - Phone:407-251-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120020363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical