Stacy Jean

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11004751 Issued in FL

Practice address

19531 Cochran Blvd
Port Charlotte, FL 33948-2081

Phone

(941) 255-3535

Fax

(941) 766-7999

NPI assigned

Oct 31, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: stacy.jean.1@4290.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment Care Compare group NPD
• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Cape Coral, FL
  • NPI 1760590962
  Medicare reassignment NPD
• Rd Medical Professional Services PC

  • Family Medicine Physician
  • Staten Island, NY
  • NPI 1811643166

  FL

  Medicare reassignment NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Millennium Home Care LLC

  • Home Health Agency
  • Port Charlotte, FL
  • NPI 1700058583
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1154965341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19531 COCHRAN BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339482081",
            "telephone_number": "941-255-3535",
            "fax_number": "941-766-7999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 Grant St",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330245840",
            "country_code": "US",
            "telephone_number": "407-922-0733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEAN",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11004751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay S. Herbst M.D., P.a.
• Alicia Jaynes
• Jean Geriatrics, PLLC
• Gerdie Jean-Smith, M.D,
• Samantha Jean, M.D.
• Jeanette Gadsden
• Jeffrey G. Bentson, M.D., PLLC
• Jeffrey Mark Greenberg MD PA
• Lian Jen, DO PA
• Jacelyn Jennings, M.O.T

• Family Nurse Practitioner in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.