Healthcare Provider Details

I. General information

NPI: 1124129358
Provider Name (Legal Business Name): STACEY JEANNE PAPPAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PALM COAST PKWY NE
PALM COAST FL
32137-3886
US

IV. Provider business mailing address

309 PALM COAST PKWY NE
PALM COAST FL
32137-3886
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-5146
  • Fax: 386-445-7464
Mailing address:
  • Phone: 386-254-5146
  • Fax: 386-445-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14404
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME93828
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD14404
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME93828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: