Healthcare Provider Details

I. General information

NPI: 1033084876
Provider Name (Legal Business Name): STACIE ZAPORTEZA AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 OAKHILL CT
PALM HARBOR FL
34683-5914
US

IV. Provider business mailing address

329 OAKHILL CT
PALM HARBOR FL
34683-5914
US

V. Phone/Fax

Practice location:
  • Phone: 813-390-2110
  • Fax:
Mailing address:
  • Phone: 813-390-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11042824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: