Basic Information
| Provider Information | |||||||||
| NPI: | 1124210067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | FERNICE | ||||||||
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| Credential: | M.D, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4881 NW 8TH AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525472373 | ||||||||
| FaxNumber: | 3524161813 | ||||||||
| Practice Location | |||||||||
| Address1: | 3304 SW 34TH CIR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344743358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522910245 | ||||||||
| FaxNumber: | 3522910231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME106910 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | ME106910 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.