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General NPI Number Information
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NPI Number | 1912810391
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Entity Type | Individual
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Provider Name | TREVOR GENE STALBAUM
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Gender | Male
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 6500 W NEWBERRY RD
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City | GAINESVILLE
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State | FL
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Zip | 32605-4309
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Country | US
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Telephone | 352-514-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 4951 SW 143RD ST
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City | STARKE
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State | FL
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Zip | 32091-6702
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Country | US
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Telephone |
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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 | RN9649912
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License Number State | FL
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