Provider Demographics
NPI:1306344916
Name:STUART, NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 CLEVELAND ST STE 227
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3234
Mailing Address - Country:US
Mailing Address - Phone:727-478-3196
Mailing Address - Fax:727-221-5312
Practice Address - Street 1:2189 CLEVELAND ST STE 227
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3234
Practice Address - Country:US
Practice Address - Phone:727-478-3196
Practice Address - Fax:727-221-5312
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist