Provider Demographics
NPI:1578144457
Name:MCCLOUD, STEPHANIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 TRAVERSE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2360
Mailing Address - Country:US
Mailing Address - Phone:267-577-0056
Mailing Address - Fax:
Practice Address - Street 1:524 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3408
Practice Address - Country:US
Practice Address - Phone:863-767-8333
Practice Address - Fax:863-767-8334
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF04210205363LF0000X
FLAPRN11019028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily