Healthcare Provider Details

I. General information

NPI: 1417464918
Provider Name (Legal Business Name): STAGES HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E MAIN ST STE 124
LAKELAND FL
33801-4655
US

IV. Provider business mailing address

122 E MAIN ST STE 124
LAKELAND FL
33801-4655
US

V. Phone/Fax

Practice location:
  • Phone: 863-837-4867
  • Fax: 863-228-8510
Mailing address:
  • Phone: 863-837-4867
  • Fax: 863-228-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012605
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. MONIQUE L MANDERSON
Title or Position: CEO/FOUNDER
Credential: FNP-C, PMHNP-BC
Phone: 863-837-4867