Provider Demographics
NPI:1477185064
Name:TAYLOR, STACY ANN
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:TAYLOR
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 1:11324 CITRA CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5950
Mailing Address - Country:US
Mailing Address - Phone:305-785-8904
Mailing Address - Fax:
Practice Address - Street 1:6536 OLD BRICK RD STE 21
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5841
Practice Address - Country:US
Practice Address - Phone:305-785-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3260171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist