Healthcare Provider Details

I. General information

NPI: 1780003913
Provider Name (Legal Business Name): STACY SPREHE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 MEDICAL DR
HUDSON FL
34667-6502
US

IV. Provider business mailing address

7529 MEDICAL DR
HUDSON FL
34667-6502
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-6524
  • Fax: 727-862-6439
Mailing address:
  • Phone: 727-862-6524
  • Fax: 727-862-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: