1669812178 NPI number — ERICA TYRENE STOKES MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669812178 NPI number — ERICA TYRENE STOKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOKES
Provider First Name:
ERICA
Provider Middle Name:
TYRENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669812178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33442-4189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-363-9582
Provider Business Mailing Address Fax Number:
954-363-9663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 GATEWAY BLVD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-572-3227
Provider Business Practice Location Address Fax Number:
561-572-3228
Provider Enumeration Date:
06/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME136982 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118513800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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