Provider Demographics
NPI:1669813614
Name:CRETUL, STEPHANIE M (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:CRETUL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 SW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7734
Mailing Address - Country:US
Mailing Address - Phone:352-622-4251
Mailing Address - Fax:352-622-0102
Practice Address - Street 1:2111 SW 20TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7734
Practice Address - Country:US
Practice Address - Phone:352-622-4251
Practice Address - Fax:352-622-0102
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9250178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009116600Medicaid
FLY0J93OtherFL BLUE
FLY0J93OtherFL BLUE