Stephanie Prudencio, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS18629 Issued in FL

Practice address

5151 N 9TH Ave
Pensacola, FL 32504-8721

Phone

(850) 416-7000

NPI assigned

Mar 20, 2019

Sex

Female

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sprudencio144319@direct.nemours.org

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.

• Sacred Heart Health System, Inc.

  • Family Medicine Physician
  • Pensacola, FL
  • NPI 1144271586
  Medicare reassignment NPD
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1386658615
  Medicare reassignment NPD
• Sacred Heart Health System Inc

  • Community/Retail Pharmacy
  • Pensacola, FL
  • NPI 1366260739
  NPD
• Sacred Heart Health System, Inc.

  • Primary Care Clinic/Center
  • Pensacola, FL
  • NPI 1043261498
  NPD
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD
• The Nemours Foundation

  • Children's Hospital
  • Wilmington, DE
  • NPI 1467505073
  NPD
• Sacred Heart Health System, Inc.

  • General Acute Care Hospital
  • Pensacola, FL
  • NPI 1922032424
  NPD (past)

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1699235200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6063",
            "fax_number": "904-539-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 N 9TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048721",
            "telephone_number": "850-416-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDENCIO",
        "first_name": "STEPHANIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-20",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS18629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Pronko
• Proprio Therapy
• Daniel Anthony Proto, PH.D.
• Leslie Diane Provis, LCSW
• Provisions of Hope LLC
• Donna Jacobi Pruett, MD
• Henry Floyd Pruett Jr., D.D.S.
• Jacqueline Pruitt
• Valerie Marie Pruitt, M.D.
• Pruitthealth - Pensacola, LLC

• Pediatrics Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.