Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Stephan Ambrose

Individual provider Physician Assistant · NPI 1356047104

Stephan Ambrose is a Physician Assistant in Miramar, Florida. Qualified in 2025, 1 year ago. Practices as a sole proprietor and works from 2 locations. Licensed in Florida and Virginia.

Years since qualifying
1
Licensed in
FL, VA
In the registry since
2023
Specialties on file
3

Practice location Address checks out

5024 SW 155th Ter
Miramar, FL 33027-5644
Phone: (754) 204-4701
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2275 Health Campus Dr Ste 1, Rockingham, VA 22801-8809 — (540) 689-4707

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9120439 (FL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Psychiatry Physician Taxonomy 2084P0800X · Licence 0110011203 (VA)

Record details

NPI number1356047104
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 3, 2023
Last updated in NPPESOctober 9, 2025
Certification dateOctober 9, 2025
Mailing address5024 Sw 155th Ter, Miramar, FL 33027-5644

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Miramar