Provider Demographics
NPI:1639651615
Name:MCBRIDE, STORMY GALE (APNP)
Entity Type:Individual
Prefix:MS
First Name:STORMY
Middle Name:GALE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:STORYM
Other - Middle Name:
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:400 LESLIE DR APT 1014
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2910
Mailing Address - Country:US
Mailing Address - Phone:305-934-8667
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1401
Practice Address - Fax:321-434-1667
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9220144363LA2200X
FLARNP9220144363LC0200X
FLAPRN9220144363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107971300Medicaid