Healthcare Provider Details

I. General information

NPI: 1063294668
Provider Name (Legal Business Name): STACEY AMBER FLORES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 CEDAR ST STE 150F
SANTA CRUZ CA
95060-3938
US

IV. Provider business mailing address

877 CEDAR ST STE 150F
SANTA CRUZ CA
95060-3938
US

V. Phone/Fax

Practice location:
  • Phone: 831-610-4034
  • Fax:
Mailing address:
  • Phone: 831-588-2908
  • Fax: 831-480-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: