Healthcare Provider Details

I. General information

NPI: 1790384162
Provider Name (Legal Business Name): AMY STABILE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 SW GATLIN BLVD
PORT ST LUCIE FL
34953-3223
US

IV. Provider business mailing address

1070 SW GATLIN BLVD
PORT SAINT LUCIE FL
34953-3223
US

V. Phone/Fax

Practice location:
  • Phone: 772-408-9434
  • Fax: 772-210-0986
Mailing address:
  • Phone: 772-408-9434
  • Fax: 772-210-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: