Healthcare Provider Details

I. General information

NPI: 1669015715
Provider Name (Legal Business Name): STACY VOILS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CENTER DR
GAINESVILLE FL
32610-3007
US

IV. Provider business mailing address

10317 SW 30TH LN
GAINESVILLE FL
32608-9091
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5276
  • Fax:
Mailing address:
  • Phone: 804-317-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPS50461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: