MEDICARE: ERIN STAVRAKAS DNP, FNP-C, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26373	SC

General Provider Information

NPI Number	:	1417670761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN STAVRAKAS DNP, FNP-C, APRN

Provider Business Mailing Address
First Line	:	2315 CHATELAIN WAY
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3278
Country	:	US
Telephone Number	:	912-665-2543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1054 JOHNNIE DODDS BLVD STE A
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3153
Country	:	US
Telephone Number	:	843-388-7545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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