Provider Demographics
NPI:1962958991
Name:SMITH, STEPHANY PEEBLES (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANY
Middle Name:PEEBLES
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
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Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:200 AVENUE F NE STE 9118
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-297-1777
Practice Address - Fax:863-297-1756
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3095132363LF0000X
FLAPRN3095132363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104789900Medicaid