Healthcare Provider Details

I. General information

NPI: 1295108322
Provider Name (Legal Business Name): STEPHANIE GRACIE A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 N ARMENIA AVE STE 102
TAMPA FL
33603-2611
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-5716
  • Fax: 813-877-4890
Mailing address:
  • Phone: 727-532-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9292259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: