Provider Demographics
NPI:1124019559
Name:STEPHENS, VERA (ARNP)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-332-0417
Mailing Address - Fax:239-334-9417
Practice Address - Street 1:3511 DR MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-4651
Practice Address - Country:US
Practice Address - Phone:239-332-0417
Practice Address - Fax:239-479-5029
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP371412363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP37623Medicare UPIN
FLY4292ZMedicare ID - Type Unspecified