Healthcare Provider Details

I. General information

NPI: 1205920493
Provider Name (Legal Business Name): STACEY B SCHMIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 DUCK SLOUGH BLVD STE 103
TRINITY FL
34655-5007
US

IV. Provider business mailing address

2160 DUCK SLOUGH BLVD STE 103
TRINITY FL
34655-5007
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-9070
  • Fax: 727-807-5801
Mailing address:
  • Phone: 727-807-9070
  • Fax: 727-807-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: