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Mrs. Stacey Cervantes

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NPI Number Detailed Information

Provider Information:

Name: Mrs. Stacey Cervantes
Gender: F
Provider License Number If Given: ARNP1477082

NPI Information:

NPI: 1629077144
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 10/10/2011

Provider Business Mailing Address:

Address: 1140 SW BASCOM NORRIS DR STE 104
Lake City, FL 32025
Phone Number: 3867196500
Fax Number: 3867196503

Provider Business Practice Location Address:

Address: 1140 SW BASCOM NORRIS DR STE 104
Lake City, FL 32025
Phone Number: 3867196500
Fax Number: 3867196503

Provider Taxonomy:

Primary: 363L00000X
Secondary (if any):
State: FL

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