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NPI Code Detail

MEDICARE: STACEY MARIE PAYNE-PETERS ARNP

MEDICARE: STACEY MARIE PAYNE-PETERS ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianARNP2743842FL
2363L00000XNurse PractitionerARNP2743842FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316494016
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY MARIE PAYNE-PETERS ARNP
Provider Business Mailing Address
First Line : 8062 SIMMONS ST
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34613-6122
Country : US
Telephone Number : 352-584-6670
Fax Number :
Provider Business Practice Location Address
First Line : 8391 OMAHA CIR
Second Line :
City : SPRING HILL
State : FL
Zip : 34606-5157
Country : US
Telephone Number : 352-678-5246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2016
Last Update Date : 12/11/2020

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