Provider Demographics
NPI:1205250560
Name:PAPPAS, STACEY (APRN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LOVELAND BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-5716
Mailing Address - Country:US
Mailing Address - Phone:941-307-3124
Mailing Address - Fax:844-339-5286
Practice Address - Street 1:2300 LOVELAND BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5716
Practice Address - Country:US
Practice Address - Phone:941-307-3124
Practice Address - Fax:844-339-5286
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045593Medicaid
FLPO1666488OtherRAILROAD MEDICARE