Healthcare Provider Details

I. General information

NPI: 1952660938
Provider Name (Legal Business Name): JANIE MADONNA DEBLAUWE LMHC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADONNA DEBLAUWE LMHC, RN

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 SE CENTRAL PKWY
STUART FL
34994-3904
US

IV. Provider business mailing address

4648 SE SALVATORI RD
STUART FL
34997-8271
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-4362
  • Fax:
Mailing address:
  • Phone: 941-526-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9425217
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: