MS. STACEY KATHLEEN BLAKE APRN FNP-C NPI 1609279082

NPI Information

NPI: 1609279082
Provider Name: MS. STACEY KATHLEEN BLAKE, APRN, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1250 PINE RIDGE RD STE 101B
NAPLES, FL
ZIP 34108
Phone: (239) 919-7009
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MS. Stacey Kathleen Blake, APRN, FNP-C is a family nurse practitioner in Naples, FL. MS. Stacey Kathleen Blake, APRN, FNP-C NPI is 1609279082. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1250 PINE RIDGE RD STE 101B
NAPLES, FL
ZIP 34108-913
Phone: (239) 919-7009

The NPI 1609279082 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 9/30/2014 and was last updated on 12/3/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363L00000X	Nurse Practitioner		3008973	KENTUCKY	No
2	363LF0000X	Nurse Practitioner	Family	3008973	KENTUCKY	No
3	363LF0000X	Nurse Practitioner	Family	9467859	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100356460	MEDICAID	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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