Provider Demographics
NPI:1922554583
Name:STONEBRAKER, MARY ELIZABETH (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:STONEBRAKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 SE 25TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3238
Mailing Address - Country:US
Mailing Address - Phone:239-699-1082
Mailing Address - Fax:239-984-8873
Practice Address - Street 1:2034 SE 25TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3238
Practice Address - Country:US
Practice Address - Phone:239-699-1082
Practice Address - Fax:239-984-8873
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN79913-NP-C363LF0000X
FLAPRN11001343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily