1043718521 NPI number — DR. JILLIAN AUDREYA FAWN STUPER DNP, MSN, FNP-BC

Table of content: DR. JILLIAN AUDREYA FAWN STUPER DNP, MSN, FNP-BC (NPI 1043718521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043718521 NPI number — DR. JILLIAN AUDREYA FAWN STUPER DNP, MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUPER
Provider First Name:
JILLIAN
Provider Middle Name:
AUDREYA FAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, MSN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRAHAN
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
AUDREYA FAWN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043718521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14405 BIRCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-364-4393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21705 BOWMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-364-4393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9344892 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)