Healthcare Provider Details

I. General information

NPI: 1619887387
Provider Name (Legal Business Name): STEPHANIE PIERRE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 LIVE OAK BLVD
ST. CLOUD FL
34771
US

IV. Provider business mailing address

2032 W BARLINGTON DR
DELTONA FL
32725-3368
US

V. Phone/Fax

Practice location:
  • Phone: 407-374-6630
  • Fax:
Mailing address:
  • Phone: 407-374-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11050501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: