Stacey Kathleen Blake, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9467859 Issued in FL

Practice address

1250 Pine Ridge Rd Ste 101B
Naples, FL 34108-8913

Phone

(239) 919-7009

NPI assigned

Sep 30, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1609279082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 REGENCY RD",
            "address_2": "SUITE 501",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405032335",
            "telephone_number": "859-523-7398",
            "fax_number": "859-687-9648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 PINE RIDGE RD STE 101B",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341088913",
            "telephone_number": "239-919-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "STACEY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-30",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3008973",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3008973",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9467859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100356460",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Marie Blackburn, PTA
• Monika Blackmon
• Brian Paul Blaine, PHARMACIST
• Kristin Nicole Blair, DDS
• Jeanne Marie Blake
• Victoria Blake
• Bryon Paul Blanchard, MD
• Nathali Blanco Cabo, RBT-25-415301
• Alejandro Blanco-Franco, M.D.
• Colin Blanco, PA-C

• Family Nurse Practitioner in Naples, FL
• Providers in Naples, 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 Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.