Healthcare Provider Details

I. General information

NPI: 1669776480
Provider Name (Legal Business Name): STEPHANIE KUZICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W PINEVIEW ST SUITE 1009
ALTAMONTE SPRINGS FL
32714-2007
US

IV. Provider business mailing address

125 W PINEVIEW ST SUITE 1009
ALTAMONTE SPRINGS FL
32714-2007
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-7111
  • Fax: 407-682-7180
Mailing address:
  • Phone: 407-682-7111
  • Fax: 407-682-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: