STACEY MICHELLE NEDRUD (NPI# 1891113205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891113205 |
| Entity Type | Individual |
| Full Name | STACEY MICHELLE NEDRUD |
| Credential | MD, DMD |
| Practice Address |
653-1 W 8th St Fl 2 Jacksonville FL 32209-6511 |
| Practice Telephone | 9042443689 |
| Practice Fax Number | 9042443218 |
| Mailing Telephone | 9042443689 |
| Mailing Fax Number | 9042443218 |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2019-10-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
653-1 W 8TH ST FL 2 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32209-6511 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164927513 | Richard Brandon Baker | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2018-03-28 |
| 1609379031 | Jennifer Marie Dolan | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2018-03-12 |
| 1851831747 | Demetri Howerton | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2017-02-27 |
| 1588104301 | Bang Quach | Dentist | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2017-02-27 |
| 1598204422 | Rosalie Nocella | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St Fl 2, Jacksonville, FL 32209 | 2017-02-12 |
| 1144674961 | Zareen Vaghaiwalla | Internal Medicine | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2016-04-18 |
| 1952764573 | Angela Richter | Internal Medicine | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2016-03-31 |
| 1497118285 | Russell Kinshun Fung | Internal Medicine | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2016-03-30 |
| 1750741302 | Andrew James Rockafellow | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2016-02-24 |
| 1114310943 | Sepideh Sabooree | Dentist | 653-1 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2015-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710506183 | Hayley M Shade | Student in an Organized Health Care Education/Training Program | 655 8th St. W., 4th Floor, Lrc 653-1 West 8th Street, L18, Jacksonville, FL 32209 | 2020-04-15 |
| 1407484629 | Micah Christine Turpeau | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2020-04-01 |
| 1730716366 | Nikki Javia | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St, Fl 4, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1336776061 | Samuel Kamoroff | Student in an Organized Health Care Education/Training Program | 653-1 West 8th Street, 4th Floor, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1376194092 | Donald Wayne Johnson Jr. | Pharmacist | Uf Health Jacksonville, 655 West 8th Street, Jacksonville, FL 32209 | 2019-09-24 |
| 1871141838 | Anton Daran Armstrong | Counselor | 921 N. Davis St. Bldg. B, Suite 350, Jacksonville, FL 32209 | 2019-09-03 |
| 1295296499 | Christian King | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2019-03-29 |
| 1013478403 | David William Barton | Orthopaedic Surgery | 655 W 8th St, Box C-126, Jacksonville, FL 32209 | 2019-03-27 |
| 1912497108 | Lisa Jordan | Adult Companion | 1515 W 31st St, Jacksonville, FL 32209 | 2018-05-14 |
| 1275020968 | Eloisa Anne Ello-esma | Nurse Practitioner | W. 8th Street, Jacksonville, FL 32209 | 2018-04-18 |
| Find all providers in zip 32209 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860711 | Lee Thomas Hagenbaumer | Student in an Organized Health Care Education/Training Program | 10100 Baymeadows Rd Apt 802, Jacksonville, FL 32256-7196 | 2020-10-27 |
| 1508463456 | Juana Maria Hodac | Student in an Organized Health Care Education/Training Program | 8680 Baymeadows Rd E Apt 1018, Jacksonville, FL 32256-3994 | 2020-10-05 |
| 1366053043 | Amanda Brunner | Student in an Organized Health Care Education/Training Program | 404 Henry Rd Sw, Jacksonville, AL 36265-3338 | 2020-08-14 |
| 1528679206 | Deandrea Joice Stowe | Student in an Organized Health Care Education/Training Program | 519 Ladiga St Se, Jacksonville, AL 36265-2691 | 2020-08-14 |
| 1558970558 | Imran Ahmed Mridha | Student in an Organized Health Care Education/Training Program | 7932 Southside Blvd Apt 2409, Jacksonville, FL 32256-7958 | 2020-07-24 |
| 1750908588 | Irissel Rodriguez | Student in an Organized Health Care Education/Training Program | 2800 University Blvd S Apt 282, Jacksonville, FL 32216-2587 | 2020-06-27 |
| 1629692413 | Diana Piotrowski | Student in an Organized Health Care Education/Training Program | 100 Magnolia St Apt 6105, Jacksonville, FL 32204-2256 | 2020-06-08 |
| 1922622778 | Ryan D'armond Navarre | Student in an Organized Health Care Education/Training Program | 100 Magnolia St Apt 6213, Jacksonville, FL 32204-2257 | 2020-06-07 |
| 1063036937 | Karen Rebecca Clement | Student in an Organized Health Care Education/Training Program | 4929 Skyway Dr Apt 5212, Jacksonville, FL 32246-0047 | 2020-06-05 |
| 1134743107 | Christine Lalime | Student in an Organized Health Care Education/Training Program | 220 Riverside Ave Unit 203, Jacksonville, FL 32202-4947 | 2020-06-04 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32209 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.