Provider Demographics
NPI:1669776480
Name:KUZICKI, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KUZICKI
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 1:125 W PINEVIEW ST
Mailing Address - Street 2:SUITE 1009
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2007
Mailing Address - Country:US
Mailing Address - Phone:407-682-7111
Mailing Address - Fax:407-682-7180
Practice Address - Street 1:125 W PINEVIEW ST
Practice Address - Street 2:SUITE 1009
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2007
Practice Address - Country:US
Practice Address - Phone:407-682-7111
Practice Address - Fax:407-682-7180
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist