Basic Information
| Provider Information | |||||||||
| NPI: | 1669813614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRETUL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROBERT FELDMAN MD PA # 176 | ||||||||
| Address2: | PO BOX 850001 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523549000 | ||||||||
| FaxNumber: | 3523549020 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SW 11TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523549000 | ||||||||
| FaxNumber: | 3523549020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2013 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9250178 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 009116600 | 05 | FL | MEDICAID | Y0J93 | 01 | FL | FL BLUE | OTHER |