Healthcare Provider Details

I. General information

NPI: 1639757651
Provider Name (Legal Business Name): STEPHANIE ELIZABETH CROITORU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CRYSTAL RIVER DR
COCOA BEACH FL
32931-2829
US

IV. Provider business mailing address

37 CRYSTAL RIVER DR
COCOA BEACH FL
32931-2829
US

V. Phone/Fax

Practice location:
  • Phone: 321-208-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS21157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: