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General NPI Number Information
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NPI Number | 1417464918
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Entity Type | Organization
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Legal Business Name | STAGES HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 122 E MAIN ST STE 124
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City | LAKELAND
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State | FL
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Zip | 33801-4655
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Country | US
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Telephone | 863-837-4867
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Fax | 863-228-8510
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Provider Business Mailing Address
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Address Line | 122 E MAIN ST STE 124
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City | LAKELAND
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State | FL
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Zip | 33801-4655
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Country | US
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Telephone | 863-837-4867
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Fax | 863-228-8510
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MS. MONIQUE L MANDERSON
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Credential | FNP-C, PMHNP-BC
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Telephone | 863-837-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.012605
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License Number State | IL
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