Provider Demographics
NPI:1366835522
Name:STEC, JETTY
Entity Type:Individual
Prefix:
First Name:JETTY
Middle Name:
Last Name:STEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 NE 42ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-2179
Mailing Address - Country:US
Mailing Address - Phone:479-739-0233
Mailing Address - Fax:
Practice Address - Street 1:2801 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7406
Practice Address - Country:US
Practice Address - Phone:352-332-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist