Provider Demographics
NPI:1619109485
Name:NIGHTINGALE, STEPHANIE LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD
Mailing Address - Street 2:#204
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2476
Mailing Address - Country:US
Mailing Address - Phone:941-955-1850
Mailing Address - Fax:941-955-1852
Practice Address - Street 1:943 S BENEVA RD
Practice Address - Street 2:#204
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2476
Practice Address - Country:US
Practice Address - Phone:941-955-1850
Practice Address - Fax:941-955-1852
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH598ZMedicare PIN