Healthcare Provider Details

I. General information

NPI: 1750174561
Provider Name (Legal Business Name): STANLEY WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 45TH ST SW
NAPLES FL
34116-6325
US

IV. Provider business mailing address

2165 45TH ST SW
NAPLES FL
34116-6325
US

V. Phone/Fax

Practice location:
  • Phone: 239-298-6620
  • Fax:
Mailing address:
  • Phone: 239-298-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: