MEDICARE: STAGES HEALTH & WELLNESS, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner	209.012605	IL

General Provider Information

NPI Number	:	1417464918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAGES HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	122 E MAIN ST STE 124
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4655
Country	:	US
Telephone Number	:	863-837-4867
Fax Number	:	863-228-8510

Provider Business Practice Location Address
First Line	:	122 E MAIN ST STE 124
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4655
Country	:	US
Telephone Number	:	863-837-4867
Fax Number	:	863-228-8510

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MS. MONIQUE L MANDERSON
Credential	:	FNP-C, PMHNP-BC
Telephone Number	:	863-837-4867

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	02/18/2026

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