Provider Demographics
NPI:1598084428
Name:STEPHENS, ERICKA E (APRN, LCSW)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTH BLVD E # 1020
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7547
Mailing Address - Country:US
Mailing Address - Phone:863-419-7645
Mailing Address - Fax:863-419-7655
Practice Address - Street 1:1 SOUTH BLVD E # 1020
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7547
Practice Address - Country:US
Practice Address - Phone:863-419-7645
Practice Address - Fax:863-419-7655
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLRN9418147163W00000X
FL9418147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse