Healthcare Provider Details

I. General information

NPI: 1932206091
Provider Name (Legal Business Name): KEVIN D STAPLETON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 RINEHART RD STE 2001
LAKE MARY FL
32746-5252
US

IV. Provider business mailing address

454 RINEHART RD STE 2001
LAKE MARY FL
32746-5252
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 321-842-2495
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-842-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0002602
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: