Provider Demographics
NPI:1588959118
Name:STEPHEN, ANI (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SE 12TH ST
Mailing Address - Street 2:APT#104
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4665
Mailing Address - Country:US
Mailing Address - Phone:954-803-6106
Mailing Address - Fax:
Practice Address - Street 1:545 SE 12TH ST
Practice Address - Street 2:APT#104
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4665
Practice Address - Country:US
Practice Address - Phone:954-803-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9230846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily