Healthcare Provider Details

I. General information

NPI: 1912383043
Provider Name (Legal Business Name): STACY FIFER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 GRUMMAN PL STE B
TITUSVILLE FL
32780-7927
US

IV. Provider business mailing address

1250 GRUMMAN PL STE B
TITUSVILLE FL
32780-7927
US

V. Phone/Fax

Practice location:
  • Phone: 321-269-4240
  • Fax: 321-269-5248
Mailing address:
  • Phone: 321-269-4240
  • Fax: 321-269-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberAPRN9309754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: