MEDICARE: STACI BEHM RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9531247	FL

General Provider Information

NPI Number	:	1215820105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI BEHM RN, BSN

Provider Business Mailing Address
First Line	:	217 MIRACLE STRIP PKWY SE STE 104
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5819
Country	:	US
Telephone Number	:	850-376-3197
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 MIRACLE STRIP PKWY SE STE 104
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5819
Country	:	US
Telephone Number	:	850-376-3197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	06/26/2025

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