Healthcare Provider Details

I. General information

NPI: 1740778885
Provider Name (Legal Business Name): NICOLE STANINA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26246 WESLEY CHAPEL BLVD # 2007
LUTZ FL
33559-7206
US

IV. Provider business mailing address

26246 WESLEY CHAPEL BLVD # 2007
LUTZ FL
33559-7206
US

V. Phone/Fax

Practice location:
  • Phone: 813-543-6391
  • Fax:
Mailing address:
  • Phone: 813-543-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22783
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: