MEDICARE: TODD STACEY LUDWIG PMHNP

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	APRN11005390	FL

General Provider Information

NPI Number	:	1952949208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD STACEY LUDWIG PMHNP

Provider Business Mailing Address
First Line	:	355 S OCEAN DR APT 806
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3282
Country	:	US
Telephone Number	:	772-828-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 S OCEAN DR APT 806
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3282
Country	:	US
Telephone Number	:	772-828-7277
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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