Healthcare Provider Details

I. General information

NPI: 1629374491
Provider Name (Legal Business Name): FERQUITA STOKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 DUNLAWTON AVE
PORT ORANGE FL
32127-4931
US

IV. Provider business mailing address

PO BOX 923
APOPKA FL
32704-0923
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-8584
  • Fax: 386-767-8536
Mailing address:
  • Phone: 386-299-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11021382
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN 9218979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: