Stacy Black, APRN
Individual provider Active NPI Nurse Practitioner · Parkland, FL
NPI 1659030856 · NPPES record last updated Dec 15, 2021
Key facts
- NPI
- 1659030856
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN11016313 (FL)
- Practice address
- 8701 Waterview Ter
Parkland, FL 33076-2868 - Phone
- (954) 729-0195
- NPI assigned
- Dec 15, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Florida Surgical Specialists LLC
Practice addresses (Care Compare)
4515 Wiles Rd
Suite 201
Coconut Creek, FL 33073-3414
Phone (954) 943-1133
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230822002070 | FL | Practitioner - Nurse Practitioner | 3173985256 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN11016313 | FL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Florida Surgical Specialists LLC | Current |
Accepting new patients |
Locations
4515 Wiles Rd
Ste 201
Coconut Creek, FL 33073
Phone (954) 943-1133
3000 Coral Hills Dr
Pompano Beach, FL 33065
Phone (954) 344-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN11016313 | FL | Yes |
Addresses
Primary practice location
8701 Waterview Ter
Parkland, FL 33076-2868
Mailing address
8701 Waterview Ter
Parkland, FL 33076-2868
Other providers in Parkland, FL
- Rhonda Avery Bilsker Pearl
- Darrah Bingman
- Shanna Birdie
- Bit-by-Bit,Inc.
- BJ'S Wholesale Club Inc.
- Apalonia Blanchard
- Jenyfeer Blanco
- Eric Lawrence Blicker
- Amy M Bloom
- Joseph M Bogart
All providers in Parkland, FL · Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.