Basic Information
Provider Information
NPI: 1659634574
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: IHNOW
FirstName: STEPHANIE
MiddleName: BROWN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3450 HULL RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326074144
CountryCode: US
TelephoneNumber: 3522737002
FaxNumber: 3522737388
Practice Location
Address1: 3450 HULL RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326074144
CountryCode: US
TelephoneNumber: 3522737001
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2012
LastUpdateDate: 10/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X125062145ILN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207X00000XME138169FLY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
10165610005FL MEDICAID


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