Provider Demographics
NPI:1962957829
Name:TURCO, STEPHANIE O (PA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:O
Last Name:TURCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:OLTHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:86 W UNDERWOOD ST # MP80
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:888-912-3648
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:86 W UNDERWOOD ST # MP80
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:888-912-3648
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9109702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018563900Medicaid
FLIR850ZMedicare PIN