Provider Demographics
NPI:1790114965
Name:FERRARA, STEPHANIE (CRNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LEBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2125 ROUTE 88 E
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3273
Mailing Address - Country:US
Mailing Address - Phone:732-892-4548
Mailing Address - Fax:732-892-0961
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-5405
Practice Address - Country:US
Practice Address - Phone:609-250-4110
Practice Address - Fax:609-978-8977
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily