Healthcare Provider Details

I. General information

NPI: 1447058029
Provider Name (Legal Business Name): STACEY L GOMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 49TH ST N STE 208
ST PETERSBURG FL
33709-2100
US

IV. Provider business mailing address

5800 49TH ST N STE 208
ST PETERSBURG FL
33709-2100
US

V. Phone/Fax

Practice location:
  • Phone: 727-892-2928
  • Fax:
Mailing address:
  • Phone: 727-892-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11048707
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11048707
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11048707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: