Healthcare Provider Details

I. General information

NPI: 1205735115
Provider Name (Legal Business Name): STEPHANIE SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2846
US

IV. Provider business mailing address

911 S COLONIAL CT APT D
INDIAN HARBOUR BEACH FL
32937-2624
US

V. Phone/Fax

Practice location:
  • Phone: 321-735-8960
  • Fax:
Mailing address:
  • Phone: 321-614-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11052129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: