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NPI Code Detail

MEDICARE: STACY TWIGG P.A.

MEDICARE: STACY TWIGG P.A.
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
1363AS0400XSurgical Physician Assistant085001809IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209119OTHERILMEDICARE PTAN LOCALITY 16
2209118OTHERILMEDICARE PTAN LOCALITY 15

General Provider Information

NPI Number : 1467406512
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY TWIGG P.A.
Provider Business Mailing Address
First Line : 1827 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-7605
Country : US
Telephone Number : 850-785-4344
Fax Number : 850-785-6568
Provider Business Practice Location Address
First Line : 1827 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-7605
Country : US
Telephone Number : 850-785-4344
Fax Number : 850-785-6568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 07/01/2024

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Directions to “ STACY TWIGG P.A.” Practice Location

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