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General NPI Number Information
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NPI Number | 1255022471
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Entity Type | Individual
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Provider Name | STEPHANIE RANALLO APRN
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Gender | Female
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1978 ROCKLEDGE BLVD STE 103
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City | ROCKLEDGE
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State | FL
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Zip | 32955-3722
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Country | US
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Telephone | 321-508-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 7455 S US HIGHWAY 1 STE B
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City | TITUSVILLE
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State | FL
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Zip | 32780-8115
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Country | US
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Telephone | 321-557-4821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN11025702
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License Number State | FL
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