Individual
STEPHANIE L TALBOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8725 N WICKHAM RD STE 200, MELBOURNE, FL 32940-2240
(321) 434-9230
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-9230
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9113547
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109896800
—
FL
01
—
NN750
MEDICARE HF
FL
Enumeration date
09/14/2020
Last updated
11/28/2022
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