Provider Demographics
NPI:1952741845
Name:FISH, STEPHANIE DEAN (PMHNP-BC, MSN, ARNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DEAN
Last Name:FISH
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EAST SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3122
Mailing Address - Country:US
Mailing Address - Phone:321-952-6000
Mailing Address - Fax:321-952-6010
Practice Address - Street 1:2020 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2335
Practice Address - Country:US
Practice Address - Phone:321-952-6000
Practice Address - Fax:321-952-6010
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2925952364SP0808X, 101YM0800X
FLRN2925952163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health