MEDICARE: STACIE E ALLEN ARNP PMHNP-BC

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	2084P0800X	Psychiatry Physician	11026900	FL

General Provider Information

NPI Number	:	1487339206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE E ALLEN ARNP PMHNP-BC

Provider Business Mailing Address
First Line	:	1653 SE NORTH BLACKWELL DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6651
Country	:	US
Telephone Number	:	717-315-9731
Fax Number	:	717-251-1570

Provider Business Practice Location Address
First Line	:	1653 SE NORTH BLACKWELL DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6651
Country	:	US
Telephone Number	:	480-864-3870
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	05/26/2024

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