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Individual
STACY WADE
Active
Individual
STACY WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28150715A
IN
363LF0000X
Family Nurse Practitioner
71002094A
IN
363LF0000X
Family Nurse Practitioner
Primary
APRN11012868
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112417400
—
FL
05
—
200903990
—
IN
01
—
P01307686
MEDICARE RR PTAN
IN
Enumeration date
06/06/2008
Last updated
01/04/2023
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