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General NPI Number Information
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NPI Number | 1770418410
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Entity Type | Individual
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Provider Name | KRISTY STAUBACH
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Gender | Female
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Dates
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Enumeration Date | 06/15/2026
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 2001 S MCCALL RD STE D
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City | ENGLEWOOD
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State | FL
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Zip | 34223-4500
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Country | US
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Telephone | 941-300-6426
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Fax |
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Provider Business Mailing Address
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Address Line | 5285 FARLEY ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-5026
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Country | US
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Telephone | 318-820-7770
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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 | RN9557723
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License Number State | FL
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