Provider Demographics
NPI:1598156655
Name:STOECKICHT, JUDITH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:STOECKICHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 MERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1214
Mailing Address - Country:US
Mailing Address - Phone:727-786-7388
Mailing Address - Fax:
Practice Address - Street 1:2738 MERLIN WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1214
Practice Address - Country:US
Practice Address - Phone:727-786-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5166547164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse