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General NPI Number Information
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NPI Number | 1750718805
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Entity Type | Individual
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Provider Name | TERESA KAY STACY
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 12124 HIGH TECH AVE SUITE 300
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City | ORLANDO
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State | FL
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Zip | 32817-8373
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Country | US
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Telephone | 888-300-5132
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Fax |
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Provider Business Mailing Address
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Address Line | 12124 HIGH TECH AVE SUITE 300
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City | ORLANDO
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State | FL
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Zip | 32817-8373
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Country | US
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Telephone | 888-300-5132
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2285524
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 116943
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License Number State | MO
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