Provider Demographics
NPI:1629766985
Name:MCCLELLAND, STACY MAY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MAY
Last Name:MCCLELLAND
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 1:30115 COUNTY ROAD 52 STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-8243
Mailing Address - Country:US
Mailing Address - Phone:813-467-4244
Mailing Address - Fax:813-467-4246
Practice Address - Street 1:30115 COUNTY ROAD 52 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-8243
Practice Address - Country:US
Practice Address - Phone:813-467-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily