MEDICARE: CRYSTAL ELLEN STOKES LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	3339	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3339	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1841604535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ELLEN STOKES LAC

Provider Business Mailing Address
First Line	:	1503 ENGLE ROAD ROAD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947
Country	:	US
Telephone Number	:	772-201-3226
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 ANGLE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-7016
Country	:	US
Telephone Number	:	772-201-3226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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Directions to “ CRYSTAL ELLEN STOKES LAC” Practice Location

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