STACY WADE NP NPI 1770742462

NPI Information

NPI: 1770742462
Provider Name: STACY WADE, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
2780 CLEVELAND AVE STE 819
FORT MYERS, FL
ZIP 33901
Phone: (239) 343-3800
Get Directions

Stacy Wade, NP is a family nurse practitioner in Fort Myers, FL. Stacy Wade, NP NPI is 1770742462. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2780 CLEVELAND AVE STE 819
FORT MYERS, FL
ZIP 33901-817
Phone: (239) 343-3800
Fax: (239) 343-3993

The NPI 1770742462 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/6/2008 and was last updated on 1/4/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363L00000X	Nurse Practitioner		28150715A	INDIANA	No
2	363LF0000X	Nurse Practitioner	Family	71002094A	INDIANA	No
3	363LF0000X	Nurse Practitioner	Family	APRN11012868	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200903990	MEDICAID	INDIANA
2	P01307686	OTHER	INDIANA	MEDICARE RR PTAN
3	112417400	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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