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General NPI Number Information
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NPI Number | 1295108322
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Entity Type | Individual
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Provider Name | STEPHANIE GRACIE A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 4683 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4880
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Country | US
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Telephone | 727-686-9609
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Fax |
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Provider Business Mailing Address
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Address Line | 1387 E LAKE WOODLANDS PKWY
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City | OLDSMAR
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State | FL
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Zip | 34677-1922
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Country | US
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Telephone | 727-686-9609
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9292259
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP9292259
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License Number State | FL
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