Healthcare Provider Details

I. General information

NPI: 1942049051
Provider Name (Legal Business Name): STEPHANIE MYERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19701 KELLY RD
FORT PIERCE FL
34945-4710
US

IV. Provider business mailing address

19701 KELLY RD
FORT PIERCE FL
34945-4710
US

V. Phone/Fax

Practice location:
  • Phone: 772-370-3649
  • Fax:
Mailing address:
  • Phone: 772-370-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: