Individual
STACEY-ANN SOARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9407196
FL
363LA2200X
Adult Health Nurse Practitioner
4052572
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9407196
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013961500
—
FL
05
—
101473000
—
FL
01
—
JC020Z
MEDICARE
FL
Enumeration date
07/23/2013
Last updated
03/18/2026
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