MEDICARE: STACEY LYNN LAROCHE APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11046514	FL

General Provider Information

NPI Number	:	1609691906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LYNN LAROCHE APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	1235 PROVIDENCE BLVD # R53
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7363
Country	:	US
Telephone Number	:	386-222-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 PROVIDENCE BLVD # R53
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7363
Country	:	US
Telephone Number	:	386-222-3978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	06/26/2025

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