Healthcare Provider Details

I. General information

NPI: 1952741845
Provider Name (Legal Business Name): STEPHANIE DEAN FISH PMHNP-BC, MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 COMMERCE DR
MELBOURNE FL
32904-2335
US

IV. Provider business mailing address

400 EAST SHERIDAN RD
MELBOURNE FL
32901-3122
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-6000
  • Fax: 321-952-6010
Mailing address:
  • Phone: 321-952-6000
  • Fax: 321-952-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP2925952
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberARNP2925952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: