Provider Demographics
NPI:1396977708
Name:WARDEN, STEPHEN VINCENT (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:VINCENT
Last Name:WARDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:861 SW 78TH AVE
Mailing Address - Street 2:#200B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3273
Mailing Address - Country:US
Mailing Address - Phone:877-693-5700
Mailing Address - Fax:954-625-6034
Practice Address - Street 1:861 SW 78TH AVE
Practice Address - Street 2:#200B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3273
Practice Address - Country:US
Practice Address - Phone:877-693-5700
Practice Address - Fax:954-625-6034
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant