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DEMETRIUS STALLWORTH
NPI 1629506274
Licensed Practical Nurse in Orange Park, FL

Active since May 26, 2017
490 VINEYARD LN, ORANGE PARK, FL 32073(904) 233-2008 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 21, 2022, May 26, 2017 (2 updates tracked since 2017).

About Demetrius Stallworth NPPES

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

DEMETRIUS STALLWORTH (NPI 1629506274) is an individual licensed practical nurse in Orange Park, Florida, licensed in Florida (PN5192381) and active in the NPI registry since May 2017.

NPPES Registry Identity

NPI1629506274
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameDEMETRIUS STALLWORTH
Location Address490 VINEYARD LNOrange Park, FL 32073-7678
Mailing Address490 Vineyard LnOrange Park, FL 32073-7678 · (904) 233-2008
Phone(904) 233-2008
Sole ProprietorNo
Enumeration DateMay 26, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1629506274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in FL · PN5192381
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
490 VINEYARD LN, Orange Park, FL 32073
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Demetrius Stallworth's NPI number?

The NPI number for Demetrius Stallworth is 1629506274. It was assigned to this individual provider in the NPPES registry on May 26, 2017.

Where is Demetrius Stallworth located?

Demetrius Stallworth practices at 490 Vineyard Ln, Orange Park, FL 32073. The listed phone number is (904) 233-2008.

What is Demetrius Stallworth's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Demetrius Stallworth was last updated on July 21, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.