Healthcare Provider Details

I. General information

NPI: 1750216461
Provider Name (Legal Business Name): NICOLE STETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKI STETZ

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 8TH AVE SW P.O. BOX 378
LARGO FL
33770-3638
US

IV. Provider business mailing address

50 8TH AVE SW P.O. BOX 378
LARGO FL
33770-3638
US

V. Phone/Fax

Practice location:
  • Phone: 727-251-8535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: