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General NPI Number Information
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NPI Number | 1629077144
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Entity Type | Individual
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Provider Name | STACEY CERVANTES ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1140 SW BASCOM NORRIS DR STE 104
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City | LAKE CITY
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State | FL
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Zip | 32025-1329
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Country | US
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Telephone | 386-719-6500
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Fax | 386-719-6503
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Provider Business Mailing Address
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Address Line | 1140 SW BASCOM NORRIS DR STE 104
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City | LAKE CITY
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State | FL
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Zip | 32025-1329
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Country | US
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Telephone | 386-719-6500
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Fax | 386-719-6503
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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 | ARNP1477082
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License Number State | FL
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