Healthcare Provider Details

I. General information

NPI: 1669661658
Provider Name (Legal Business Name): STEPHANIE ANN CRITES ARNP,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6059
  • Fax: 904-209-6002
Mailing address:
  • Phone: 904-209-6059
  • Fax: 904-209-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9203447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: