Provider Demographics
NPI:1104419712
Name:STUCKEY, KRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:STUCKEY
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 1:777 TURTLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-5315
Mailing Address - Country:US
Mailing Address - Phone:772-538-3137
Mailing Address - Fax:
Practice Address - Street 1:777 TURTLE COVE LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-5315
Practice Address - Country:US
Practice Address - Phone:772-538-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion