Healthcare Provider Details

I. General information

NPI: 1003730524
Provider Name (Legal Business Name): STEPHANIE CRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1186 SANDY ST
PORT CHARLOTTE FL
33952-1127
US

IV. Provider business mailing address

1186 SANDY ST
PORT CHARLOTTE FL
33952-1127
US

V. Phone/Fax

Practice location:
  • Phone: 605-408-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDR141561.
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: