MEDICARE: TERESA KAY STACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2285524	MA
2	163WG0000X	General Practice Registered Nurse	116943	MO

General Provider Information

NPI Number	:	1750718805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA KAY STACY

Provider Business Mailing Address
First Line	:	12124 HIGH TECH AVE
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32817-8373
Country	:	US
Telephone Number	:	888-300-5132
Fax Number	:

Provider Business Practice Location Address
First Line	:	12124 HIGH TECH AVE
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32817-8373
Country	:	US
Telephone Number	:	888-300-5132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	12/14/2025

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Directions to “ TERESA KAY STACY ” Practice Location

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