MEDICARE: STEPHANIE JEAN

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	11044593	FL

General Provider Information

NPI Number	:	1821954868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JEAN

Provider Business Mailing Address
First Line	:	1801 SE HILLMOOR DR STE C-102
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7550
Country	:	US
Telephone Number	:	813-999-1516
Fax Number	:	813-441-8519

Provider Business Practice Location Address
First Line	:	1801 SE HILLMOOR DR STE C-102
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7550
Country	:	US
Telephone Number	:	813-999-1516
Fax Number	:	813-441-8519

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

Provider Enumeration Date	:	01/03/2026
Last Update Date	:	06/15/2026

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