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:ROBERT FELDMAN MD PA # 176
Mailing Address - Street 2:PO BOX 850001
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0176
Mailing Address - Country:US
Mailing Address - Phone:352-354-9000
Mailing Address - Fax:352-354-9020
Practice Address - Street 1:125 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0967
Practice Address - Country:US
Practice Address - Phone:352-354-9000
Practice Address - Fax:352-354-9020
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2021-08-09
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