Healthcare Provider Details

I. General information

NPI: 1932906260
Provider Name (Legal Business Name): STEPHANIE NICOLE LACRET CRPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99198 OVERSEAS HWY STE 3-5
KEY LARGO FL
33037-2455
US

IV. Provider business mailing address

99198 OVERSEAS HWY STE 3-5
KEY LARGO FL
33037-2455
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPS.0101458.A
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: