Healthcare Provider Details

I. General information

NPI: 1881272771
Provider Name (Legal Business Name): STACEY JEFFERIES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 DOUGLAS AVE STE 102
ALTAMONTE SPRINGS FL
32714-5201
US

IV. Provider business mailing address

108 DEVON CT
LONGWOOD FL
32779-5713
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-8501
  • Fax:
Mailing address:
  • Phone: 321-305-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11012450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: