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General NPI Number Information
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NPI Number | 1831077734
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Entity Type | Individual
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Provider Name | ETHAN THOMAS STUART APRN-C
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Gender | Male
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 6145 W. IRLO BRONSON MEMORIAL HWY
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City | CELEBRATION
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State | FL
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Zip | 34747-5432
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Country | US
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Telephone | 407-303-4655
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Fax | 407-303-4654
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Provider Business Mailing Address
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Address Line | 8556 COVENTRY PARK WAY
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City | WINDERMERE
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State | FL
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Zip | 34786-0295
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Country | US
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Telephone | 417-254-4850
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11040373
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License Number State | FL
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