Healthcare Provider Details

I. General information

NPI: 1184013674
Provider Name (Legal Business Name): STACY LIVINGSTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 S UNIVERSITY DR
DAVIE FL
33328-2000
US

IV. Provider business mailing address

2825 COCONUT AVE
MIAMI FL
33133-3724
US

V. Phone/Fax

Practice location:
  • Phone: 954-732-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9309779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: