Healthcare Provider Details

I. General information

NPI: 1033091889
Provider Name (Legal Business Name): STACEY GEDEON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 RAIN SHADOW DR
SAINT CLOUD FL
34772-6343
US

IV. Provider business mailing address

4985 RAIN SHADOW DR
SAINT CLOUD FL
34772-6343
US

V. Phone/Fax

Practice location:
  • Phone: 321-750-6711
  • Fax:
Mailing address:
  • Phone: 321-750-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11037319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: