Provider Demographics
NPI:1205854692
Name:STAPLETON, STACIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNN
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:DEPT 6500002705
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-3051
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:601 5TH ST S STE 302
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-4176
Practice Address - Fax:727-767-4379
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME984922080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278047000Medicaid