Provider Demographics
NPI:1326443532
Name:ROBERTS, STASHA-GAE ALICIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:STASHA-GAE
Middle Name:ALICIA
Last Name:ROBERTS
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Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:10150 HIGHLAND MANOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9712
Mailing Address - Country:US
Mailing Address - Phone:813-669-3084
Mailing Address - Fax:813-219-8836
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9712
Practice Address - Country:US
Practice Address - Phone:813-669-3084
Practice Address - Fax:813-706-7077
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2024-05-03
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9168956363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health