Wideman, Stacy

Wideman, Stacy is an sole proprietor health care provider with primary practice located at 8450 Nw 102Nd Ave , Doral FL 33178-4750. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Wideman, Stacy can be contacted via phone (360) 643-6562.

Contact Information

Primary practice address
8450 Nw 102Nd Ave Doral FL 33178-4750
Phone: (360) 643-6562
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X C-RXN.0001379 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X APRN61166084-NP Washington
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X RN225736 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 202104630NP-PP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 9501782 California
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 1071418 Texas
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X G168450 Iowa
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X APRN11012260 Florida

Profile Details

NPI number 1386243871
LBN Legal business name Wideman, Stacy
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 26th, 2020
Last updated Mar 1st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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