1053963793 NPI number — STEPHANIE ANN MAY APRN

Table of content: STEPHANIE ANN MAY APRN (NPI 1053963793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053963793 NPI number — STEPHANIE ANN MAY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAY
Provider First Name:
STEPHANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAULERSON
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053963793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-202-2092
Provider Business Mailing Address Fax Number:
904-376-4075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462626 STATE ROAD 200 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YULEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32097-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-225-3824
Provider Business Practice Location Address Fax Number:
904-390-7440
Provider Enumeration Date:
07/12/2019

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:  APRN11003185 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN11003185 , 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)

  • Identifier: 103595000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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