Organization Active NPI

Stonebraker Medical, LLC

  • Family Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1922892801
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
STONEBRAKER MEDICAL, LLC
Practice address
1922 Victoria Ave Ste a
Fort Myers, FL 33901-3441
Phone
(239) 699-1082
Fax
(239) 984-8873
NPI assigned
Apr 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Mary Elizabeth Stonebraker, NP-CNPI 1922554583
Title
Family Nurse Practitioner
Phone
(239) 699-1082

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1922 Victoria Ave Ste a
Fort Myers, FL 33901-3441

Mailing address

2034 SE 25TH Ter
Cape Coral, FL 33904-3238
Phone (304) 582-1990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250604002519 FL Part B Supplier - Clinic/Group Practice 9537678123 Receives reassigned benefits from 1 practitioner
Practice locations: Cape Coral, FL

National Provider Directory

National Provider Directory

Locations

1922 Victoria Ave
Ste A
Fort Myers, FL 33901
Phone (239) 264-4318

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1922892801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2034 SE 25TH TER",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339043238",
            "telephone_number": "304-582-1990",
            "fax_number": "239-984-8873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922 VICTORIA AVE STE A",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339013441",
            "telephone_number": "239-699-1082",
            "fax_number": "239-984-8873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBRAKER MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "STONEBRAKER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "239-699-1082",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.