Provider Demographics
NPI:1770119653
Name:CRENSHAW, STEPHANIE J
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:CRENSHAW
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 1:2154 WASECA LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3059
Mailing Address - Country:US
Mailing Address - Phone:352-973-2372
Mailing Address - Fax:
Practice Address - Street 1:2154 WASECA LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3059
Practice Address - Country:US
Practice Address - Phone:352-973-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider