Provider Demographics
NPI:1437793817
Name:COFFEY, STACEY HENRY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:HENRY
Last Name:COFFEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13749 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2500
Mailing Address - Country:US
Mailing Address - Phone:813-714-2888
Mailing Address - Fax:
Practice Address - Street 1:13749 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2500
Practice Address - Country:US
Practice Address - Phone:813-714-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9236814207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty