Provider Demographics
NPI:1790138337
Name:EHIGIATO, STACY HELRETIRIA
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:HELRETIRIA
Last Name:EHIGIATO
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 1:118 W MURPHY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-9440
Mailing Address - Country:US
Mailing Address - Phone:863-624-9030
Mailing Address - Fax:
Practice Address - Street 1:118 W MURPHY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-9440
Practice Address - Country:US
Practice Address - Phone:863-624-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide