Healthcare Provider Details

I. General information

NPI: 1295643310
Provider Name (Legal Business Name): ABIGAIL STACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 TAMPA RD
PALM HARBOR FL
34684-3670
US

IV. Provider business mailing address

2790 GRAND AVE APT 6101
SAINT PETERSBURG FL
33716-4135
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-5482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: