Individual
STEPHANIE ELIZABETH MACIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5812 OLD PASCO RD, WESLEY CHAPEL, FL 33544-4011
(813) 333-9108
(813) 333-9395
Mailing address
13067 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0926
(813) 779-6303
(786) 868-0012
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
ME128505
FL
2084N0400X
Neurology Physician
Primary
ME128505
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020762800
—
FL
01
—
FYRT7
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/27/2012
Last updated
03/18/2024
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