Healthcare Provider Details

I. General information

NPI: 1609781863
Provider Name (Legal Business Name): RICKI L STALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 TECH BLVD STE 122
TAMPA FL
33619-7822
US

IV. Provider business mailing address

5219 ORANGE AVE APT A
SEFFNER FL
33584-6483
US

V. Phone/Fax

Practice location:
  • Phone: 813-305-2867
  • Fax:
Mailing address:
  • Phone: 727-506-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: