Healthcare Provider Details

I. General information

NPI: 1467341495
Provider Name (Legal Business Name): NADINE FIEGE DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602E LAURA ST
STARKE FL
32091-4026
US

IV. Provider business mailing address

602 LAURA ST
STARKE FL
32091-4026
US

V. Phone/Fax

Practice location:
  • Phone: 904-200-1148
  • Fax:
Mailing address:
  • Phone: 904-200-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024493
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040809
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42142
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4056857
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: