Provider Demographics
NPI:1225363195
Name:ACKERMAN, STACIE DENISE
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:DENISE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 NW 125TH AVE
Mailing Address - Street 2:APT. 320
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6329
Mailing Address - Country:US
Mailing Address - Phone:561-706-7437
Mailing Address - Fax:561-740-9515
Practice Address - Street 1:2350 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 650
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1419
Practice Address - Country:US
Practice Address - Phone:954-731-8097
Practice Address - Fax:954-733-6892
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist