Tephanie D Soderstrom, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9101738 Issued in FL

Practice address

16900 Front Beach Rd
Panama City Beach, FL 32413-2345

Phone

(850) 234-1898

Fax

(850) 234-7670

NPI assigned

Dec 11, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1518140722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16900 FRONT BEACH RD",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324132345",
            "telephone_number": "850-234-1898",
            "fax_number": "850-234-7670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16900 FRONT BEACH RD",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324132345",
            "telephone_number": "850-234-1898",
            "fax_number": "850-234-7670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "TEPHANIE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny M Smith, LCSW
• Kathlena M Smith
• Melinda Fox Smith, MCAP, MAC
• Pamela J. Smith, M.S., SLP
• Amanda Smitherman, CRNP
• Sommer Lyn Hoyt
• Leona De Guzman Sopko
• Soulistic Counseling Corner, LLC
• South Barrett Behavioral LLC
• Southern Speech Pediatrics, LLC

• Medical Physician Assistant in Panama City Beach, FL
• Providers in Panama City Beach, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.