MEDICARE: TODD STACEY LUDWIG PMHNP

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	NP95030470	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11005390	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01168400	NJ

General Provider Information

NPI Number	:	1952949208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD STACEY LUDWIG PMHNP

Provider Business Mailing Address
First Line	:	2816 CORAL SHORES DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1256
Country	:	US
Telephone Number	:	772-828-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 CORAL SHORES DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1256
Country	:	US
Telephone Number	:	772-828-7277
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	06/18/2026

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