Provider Demographics
NPI:1750680310
Name:STOCKWELL, ERICA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:L
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:SUNSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 CELEBRATION PL FL 2
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4606
Mailing Address - Country:US
Mailing Address - Phone:407-303-4190
Mailing Address - Fax:407-303-4192
Practice Address - Street 1:380 CELEBRATION PL FL 2
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4606
Practice Address - Country:US
Practice Address - Phone:407-303-4190
Practice Address - Fax:407-303-4192
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV213503816207V00000X
NVDO1942207VX0000X
FLOS16635207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV110943Medicare PIN