Provider Demographics
NPI:1841535119
Name:KEANE, STEPHANIE (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2301
Mailing Address - Country:US
Mailing Address - Phone:772-223-5955
Mailing Address - Fax:772-223-5954
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-223-5955
Practice Address - Fax:772-223-5954
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9285694363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner