Provider Demographics
NPI:1942632260
Name:STACI APPLETON, MDPA
Entity Type:Organization
Organization Name:STACI APPLETON, MDPA
Other - Org Name:APPLETON INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-424-8440
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0278
Mailing Address - Country:US
Mailing Address - Phone:386-424-8440
Mailing Address - Fax:386-426-8839
Practice Address - Street 1:161 N CAUSEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5303
Practice Address - Country:US
Practice Address - Phone:386-424-8440
Practice Address - Fax:386-426-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377693000Medicaid
FL377693000Medicaid
FLF11110Medicare UPIN