Healthcare Provider Details

I. General information

NPI: 1295243590
Provider Name (Legal Business Name): STACIE LILLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2018
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34471-6516
US

IV. Provider business mailing address

16975 SE 27TH PLACE RD
OCKLAWAHA FL
32179-2323
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax: 407-303-0473
Mailing address:
  • Phone: 352-598-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9278130
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9278130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: