Provider Demographics
NPI:1134673239
Name:BORTLIK-HODGSON, STACEY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:BORTLIK-HODGSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:MOULTRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3928 NW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-8385
Mailing Address - Country:US
Mailing Address - Phone:904-588-4314
Mailing Address - Fax:
Practice Address - Street 1:UF HEALTH SHANDS HOSPITAL
Practice Address - Street 2:1600 SW ARCHER RD
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-265-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU7627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist