Healthcare Provider Details

I. General information

NPI: 1003773425
Provider Name (Legal Business Name): STACY ANN FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 162ND PL E
PARRISH FL
34219-1463
US

IV. Provider business mailing address

6920 162ND PL E
PARRISH FL
34219-1463
US

V. Phone/Fax

Practice location:
  • Phone: 941-303-7282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberAPRN11044735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: