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General NPI Number Information
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NPI Number | 1942632260
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Entity Type | Organization
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Legal Business Name | STACI APPLETON, MDPA
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Dates
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Enumeration Date | 08/09/2013
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 161 N CAUSEWAY SUITE C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5303
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Country | US
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Telephone | 386-424-8440
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Fax | 386-426-8839
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32170-0278
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Country | US
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Telephone | 386-424-8440
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Fax | 386-426-8839
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HOLLIE LOUCKS
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Credential |
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Telephone | 386-424-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME67829
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License Number State | FL
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