Provider Demographics
NPI:1215231097
Name:MCCORMICK, STEPHANIE (AP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 SE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-8436
Mailing Address - Country:US
Mailing Address - Phone:352-208-3675
Mailing Address - Fax:
Practice Address - Street 1:4817 NE 2ND LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-1524
Practice Address - Country:US
Practice Address - Phone:352-208-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist