Healthcare Provider Details

I. General information

NPI: 1760379812
Provider Name (Legal Business Name): STACIE ELEESE ALLINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 DOGWOOD DR
MILTON FL
32570-3546
US

IV. Provider business mailing address

5405 JOSH DR
CRESTVIEW FL
32536-2209
US

V. Phone/Fax

Practice location:
  • Phone: 850-665-2080
  • Fax:
Mailing address:
  • Phone: 850-495-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11040365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: