Provider Demographics
NPI:1487339206
Name:ALLEN, STACIE E (ARNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 SE NORTH BLACKWELL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6651
Mailing Address - Country:US
Mailing Address - Phone:717-315-9731
Mailing Address - Fax:717-251-1570
Practice Address - Street 1:1653 SE NORTH BLACKWELL DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6651
Practice Address - Country:US
Practice Address - Phone:480-864-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110269002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry