Individual provider Active NPI

Stephanie Lynn Wilson, FNP-BC

  • Nurse Practitioner
  • Lutz, FL
National Provider Identifier
1336685395
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN9479701 Issued in FL
Practice address
4211 Van Dyke Rd Ste 200
Lutz, FL 33558-8005
Phone
(813) 321-6237
Fax
(813) 463-1801
NPI assigned
Jan 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9479701 FL
Family Nurse Practitioner 363LF0000X APN0000021911 TN
Nurse Practitioner 363L00000X APRN9479701 FL Primary

Addresses

Primary practice location

4211 Van Dyke Rd Ste 200
Lutz, FL 33558-8005

Mailing address

2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 532-1355

Other identifiers 1

IdentifierTypeStateIssuer
107548200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170509000936 TN Practitioner - Nurse Practitioner 7315224995 Reassigns benefits to 1 organization
I20180711000628 FL Practitioner - Nurse Practitioner 7315224995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

2461 Enterprise Rd
Suite C
Clearwater, FL 33763-1726
Phone (727) 725-5060

4211 Van Dyke Rd
Lutz, FL 33558-8005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
21911TNMDOrthopaedic Surgery Physician
9479701FLMDFamily Nurse Practitioner
APN0000021911TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Health System, Inc Current Accepting new patients
University Health System, Inc Nurse Practitioner CurrentSince Mar 1, 2017 Accepting new patients
Baycare Medical Group, Inc. CurrentSince Aug 31, 2020 Accepting new patients
Baycare Medical Group, Inc. Nurse Practitioner CurrentSince Aug 31, 2020 Accepting new patients
University Health System Inc CurrentSince Mar 1, 2017 Accepting new patients
Healthpoint Medical Group Inc Past Accepting new patients

Locations

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060

4211 Van Dyke Rd
Ste 200
Lutz, FL 33558
Phone (813) 264-6490

4211 Van Dyke Rd
#200
Lutz, FL 33558
Phone (813) 264-6490

9000 Executive Park Dr
Ste C200
Knoxville, TN 37923
Phone (865) 670-6142

1924 Alcoa Hwy
#U56
Knoxville, TN 37920
Phone (865) 305-9081

1924 Alcoa Hwy
#56
Knoxville, TN 37920
Phone (865) 305-9081

1924 Alcoa Hwy
Knoxville, TN 37920
Phone (865) 305-9000

Interoperability endpoints

  • Direct secure messaging: stephanie.wilsonaprn@direct.mybaycare.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1336685395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW ST FL 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337593012",
            "telephone_number": "727-532-1355",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 VAN DYKE RD STE 200",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335588005",
            "telephone_number": "813-321-6237",
            "fax_number": "813-463-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-16",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9479701",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000021911",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9479701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107548200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

Verify at the official NPI Registry.