Healthcare Provider Details

I. General information

NPI: 1710724745
Provider Name (Legal Business Name): EMMA STILTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 21ST AVE W
BRADENTON FL
34209-5605
US

IV. Provider business mailing address

17707 PALMISTE DR
BRADENTON FL
34202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-8383
  • Fax:
Mailing address:
  • Phone: 615-957-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11045318
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: