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General NPI Number Information
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NPI Number | 1124129358
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Entity Type | Individual
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Provider Name | STACEY JEANNE PAPPAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 309 PALM COAST PKWY NE
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City | PALM COAST
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State | FL
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Zip | 32137-3886
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Country | US
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Telephone | 386-254-5146
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Fax | 386-445-7464
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Provider Business Mailing Address
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Address Line | 309 PALM COAST PKWY NE
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City | PALM COAST
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State | FL
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Zip | 32137-3886
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Country | US
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Telephone | 386-254-5146
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Fax | 386-445-7464
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD14404
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME93828
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD14404
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME93828
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License Number State | FL
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