Healthcare Provider Details

I. General information

NPI: 1598913840
Provider Name (Legal Business Name): STACIE MICHELLE HAMMOND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 AIRPORT BLVD
PENSACOLA FL
32504-8633
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2340
  • Fax: 850-416-2338
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: