Healthcare Provider Details

I. General information

NPI: 1942632260
Provider Name (Legal Business Name): STACI APPLETON, MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 S RIDGEWOOD AVE
EDGEWATER FL
32141-4228
US

IV. Provider business mailing address

PO BOX 278
NEW SMYRNA BEACH FL
32170-0278
US

V. Phone/Fax

Practice location:
  • Phone: 386-957-3999
  • Fax: 386-402-7920
Mailing address:
  • Phone: 386-957-3999
  • Fax: 386-402-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME67829
License Number StateFL

VIII. Authorized Official

Name: NIKKI BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-957-3999