Provider Demographics
NPI:1851099188
Name:STEWART, DOROTHY NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:NICOLE
Last Name:STEWART
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 1:1431 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-7809
Mailing Address - Country:US
Mailing Address - Phone:850-272-9216
Mailing Address - Fax:
Practice Address - Street 1:877 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1827
Practice Address - Country:US
Practice Address - Phone:850-415-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily