Individual
MRS. STEPHANIE THADAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 NW SAINT LUCIE WEST BLVD, PORT SAINT LUCIE, FL 34986-1758
(772) 303-1148
Mailing address
1555 NW SAINT LUCIE WEST BLVD, PORT SAINT LUCIE, FL 34986-1758
(954) 417-5985
(754) 339-0006
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11031757
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
406512
NY
Other
Enumeration date
03/22/2024
Last updated
05/04/2026
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