STACY WIDEMAN NPI 1386243871

NPI Information

  • NPI: 1386243871
  • Provider Name: STACY WIDEMAN
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 8450 NW 102ND AVE
    DORAL, FL
    ZIP 33178
  • Phone: (360) 643-6562

Map and Directions

Get Directions

NPI Details

Stacy Wideman is a psychiatric/mental health nurse practitioner in Doral, FL. Stacy Wideman NPI is 1386243871. 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:

8450 NW 102ND AVE
DORAL, FL
ZIP 33178-750
Phone: (360) 643-6562

The NPI 1386243871 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 10/26/2020 and was last updated on 3/1/2023.

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
1363LP0808XNurse PractitionerPsychiatric/Mental HealthC-RXN.0001379COLORADONo
2363LP0808XNurse PractitionerPsychiatric/Mental HealthAPRN61166084-NPWASHINGTONNo
3363LP0808XNurse PractitionerPsychiatric/Mental HealthRN225736GEORGIANo
4363LP0808XNurse PractitionerPsychiatric/Mental Health202104630NP-PPOREGONNo
5363LP0808XNurse PractitionerPsychiatric/Mental Health9501782CALIFORNIANo
6363LP0808XNurse PractitionerPsychiatric/Mental Health1071418TEXASNo
7363LP0808XNurse PractitionerPsychiatric/Mental HealthG168450IOWANo
8363LP0808XNurse PractitionerPsychiatric/Mental HealthAPRN11012260FLORIDAYes

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: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI