MEDICARE: STELLA TKACHENKO FNP-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	363LF0000X	Family Nurse Practitioner	APRN11037748	FL

General Provider Information

NPI Number	:	1871447540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA TKACHENKO FNP-BC

Provider Business Mailing Address
First Line	:	2408 FILLMORE ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4306
Country	:	US
Telephone Number	:	347-866-9988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2408 FILLMORE ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4306
Country	:	US
Telephone Number	:	347-866-9988
Fax Number	:

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

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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