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General NPI Number Information
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NPI Number | 1467264259
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Entity Type | Individual
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Provider Name | STACEY WILKINS CRDH
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Gender | Female
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 881 USS JAMES MADISON RD
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City | KINGS BAY
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State | GA
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Zip | 31547-2531
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Country | US
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Telephone | 407-375-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 2647 FLYCATCHER WAY
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City | SANFORD
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State | FL
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Zip | 32773-7073
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Country | US
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Telephone | 407-375-1209
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH17278
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License Number State | FL
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