Provider Demographics
NPI:1376183129
Name:CRAIG, STEPHEN JAMES (AGNP-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:CRAIG
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9565
Mailing Address - Country:US
Mailing Address - Phone:850-346-5627
Mailing Address - Fax:
Practice Address - Street 1:1408 GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9565
Practice Address - Country:US
Practice Address - Phone:850-346-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005555363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care