Healthcare Provider Details

I. General information

NPI: 1174295000
Provider Name (Legal Business Name): STACIE URBANICK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9294 TORRENT TRL
SARASOTA FL
34241-2141
US

IV. Provider business mailing address

9294 TORRENT TRL
SARASOTA FL
34241-2141
US

V. Phone/Fax

Practice location:
  • Phone: 701-306-2718
  • Fax:
Mailing address:
  • Phone: 701-306-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5015318
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: