Provider Demographics
NPI:1699106252
Name:MIRSKY, STEPHANIE MARGARET (MSN, ARNP, CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARGARET
Last Name:MIRSKY
Suffix:
Gender:F
Credentials:MSN, ARNP, CPNP-PC
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Mailing Address - Street 1:1500 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2815
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-858-0404
Practice Address - Street 1:840 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1214
Practice Address - Country:US
Practice Address - Phone:727-767-4200
Practice Address - Fax:954-858-0404
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9219040363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics