Healthcare Provider Details

I. General information

NPI: 1316494016
Provider Name (Legal Business Name): STACEY MARIE PAYNE-PETERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 OMAHA CIR
SPRING HILL FL
34606-5157
US

IV. Provider business mailing address

8062 SIMMONS ST
BROOKSVILLE FL
34613-6122
US

V. Phone/Fax

Practice location:
  • Phone: 352-678-5246
  • Fax:
Mailing address:
  • Phone: 352-584-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2743842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP2743842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: