Active NPI
Elyshia Stoutamire
- Nurse's Aide
- Macclenny, FL
National Provider Identifier
1336525229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 204621
- Practice address
- 487 Islamorada Dr S
Macclenny, FL 32063-4222 - Phone
- (904) 235-4630
- NPI assigned
- Aug 3, 2015
- Last updated
- Aug 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 204621 | FL | Primary |
Addresses
Primary practice location
487 Islamorada Dr S
Macclenny, FL 32063-4222
Mailing address
487 Islamorada Dr S
Macclenny, FL 32063-4222
Phone (904) 235-4630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204621 | FL | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438560000000",
"number": "1336525229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "487 ISLAMORADA DR S",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320634222",
"telephone_number": "904-235-4630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "487 ISLAMORADA DR S",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320634222",
"telephone_number": "904-235-4630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUTAMIRE",
"first_name": "ELYSHIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-03",
"last_updated": "2015-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "FL",
"license": "204621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.