STACY JEAN
NPI 1154965341
Nurse Practitioner - Family in Port Charlotte, FL

Q: What is Stacy Jean's NPI number?

The NPI number for Stacy Jean is 1154965341. It was assigned to this individual provider in the NPPES registry on October 31, 2019.

Q: What is Stacy Jean's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Jean was last updated on January 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 31, 2019PECOS EnrolledAccepts Medicare Assignment

19531 COCHRAN BLVD, PORT CHARLOTTE, FL 33948(941) 255-3535(941) 766-7999 Get Directions Write a Review

NPPES record last updated: January 21, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Stacy Jean NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY JEAN (NPI 1154965341) is an individual family provider in Port Charlotte, Florida, licensed in Florida (11004751) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS, maintains a secondary practice location in Hollywood, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1154965341

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSTACY JEAN

Location Address19531 COCHRAN BLVDPort Charlotte, FL 33948-2081

Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342

Phone(941) 255-3535

Fax(941) 766-7999

Sole ProprietorYes

Medical School CMSOtherGraduated 2019

Enumeration DateOctober 31, 2019

Last NPPES UpdateJanuary 21, 2025

NPPES CertifiedJanuary 21, 2025

✔ NPI 1154965341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in FL · 11004751

19531 COCHRAN BLVD, Port Charlotte, FL 33948

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Secondary Practice Location 1

Location 16500 Grant StHollywood, FL 33024-5840 · Phone (407) 922-0733

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Stacy Jean is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6002240231

PECOS Enrollment IDI20191223000285

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33948 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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