MEDICARE: STONEBRAKERS FLORIDA INC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1255938874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRAKERS FLORIDA INC

Provider Business Mailing Address
First Line	:	8210 WILLOW PT
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-7939
Country	:	US
Telephone Number	:	813-575-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	13944 LYNMAR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3123
Country	:	US
Telephone Number	:	813-575-5075
Fax Number	:	813-640-0804

Authorized Official
Title or Position	:	OWNER, EXECUTIVE DIRECTOR
Name	:	CLINT STONEBRAKER
Credential	:
Telephone Number	:	813-575-5075

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	01/03/2026

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