Individual
STEPHANIE GRACIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P.
Contact information
Practice address
4683 VAN DYKE RD, LUTZ, FL 33558-4880
(727) 686-9609
Mailing address
1387 E LAKE WOODLANDS PKWY, OLDSMAR, FL 34677-1922
(727) 686-9609
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
ARNP9292259
FL
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP9292259
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016194600
—
FL
01
—
8WLBJ
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/11/2015
Last updated
09/27/2018
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