Provider Demographics
NPI:1952949208
Name:LUDWIG, TODD STACEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STACEY
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S OCEAN DR APT 806
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-3282
Mailing Address - Country:US
Mailing Address - Phone:772-828-7277
Mailing Address - Fax:
Practice Address - Street 1:355 S OCEAN DR APT 806
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-3282
Practice Address - Country:US
Practice Address - Phone:772-828-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty