Provider Demographics
NPI:1225319288
Name:STROUD, JEFFREY MARTIN (ARNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:STROUD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4662
Mailing Address - Country:US
Mailing Address - Phone:727-553-7273
Mailing Address - Fax:727-553-7275
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-553-7273
Practice Address - Fax:727-553-7275
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12591NP363LA2200X
FL9470951363LA2200X
FLAPRN9470951363LA2200X
FLARNP9470951363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088223Medicaid
FL024359200Medicaid