Provider Demographics
NPI:1699597336
Name:JEAN, STEPHANIA
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 GRAND BAY CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1926
Mailing Address - Country:US
Mailing Address - Phone:941-667-0098
Mailing Address - Fax:
Practice Address - Street 1:1898 GRAND BAY CIR APT 204
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-1926
Practice Address - Country:US
Practice Address - Phone:941-667-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X, 344600000X
FL00-00000000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi