Healthcare Provider Details

I. General information

NPI: 1255022471
Provider Name (Legal Business Name): STEPHANIE RANALLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 ROCKLEDGE BLVD STE 103
ROCKLEDGE FL
32955-3722
US

IV. Provider business mailing address

7455 S US HIGHWAY 1 STE B
TITUSVILLE FL
32780-8115
US

V. Phone/Fax

Practice location:
  • Phone: 321-508-0999
  • Fax:
Mailing address:
  • Phone: 321-557-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11025702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: