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General NPI Number Information
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NPI Number | 1609279082
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Entity Type | Individual
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Provider Name | STACEY KATHLEEN BLAKE APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 1250 PINE RIDGE RD STE 101B
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City | NAPLES
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State | FL
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Zip | 34108-8913
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Country | US
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Telephone | 239-919-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 REGENCY RD SUITE 501
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City | LEXINGTON
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State | KY
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Zip | 40503-2335
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Country | US
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Telephone | 859-523-7398
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Fax | 859-687-9648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3008973
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License Number State | KY
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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 | 3008973
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9467859
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License Number State | FL
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