Provider Demographics
NPI:1760485189
Name:WHITTAKER, STANLEY FRANKLIN (ANP)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:FRANKLIN
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294 NW TORREYA PARK RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-2412
Mailing Address - Country:US
Mailing Address - Phone:850-643-2427
Mailing Address - Fax:850-643-1270
Practice Address - Street 1:20274 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1957
Practice Address - Country:US
Practice Address - Phone:850-353-7689
Practice Address - Fax:850-674-8889
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK587363LF0000X
FLARNP2582432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP2308Medicaid