Provider Demographics
NPI:1174514152
Name:CRISTOAICA, STEPHANIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:CRISTOAICA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1697 CROWN AVENUE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6310
Practice Address - Country:US
Practice Address - Phone:717-299-5000
Practice Address - Fax:717-431-1205
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN303273L363LC0200X
PATP006935B363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71925Medicare UPIN
064068GP6Medicare ID - Type Unspecified