Provider Demographics
NPI:1902331192
Name:CESAREC, STEPHANIE DECLUE (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DECLUE
Last Name:CESAREC
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 COUNTY ROAD 103G
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2926
Mailing Address - Country:US
Mailing Address - Phone:352-427-3966
Mailing Address - Fax:
Practice Address - Street 1:17820 SE 109TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-693-2340
Practice Address - Fax:352-693-2345
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily