Provider Demographics
NPI:1205920493
Name:SCHMIDT, STACEY B (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:B
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SE 18TH ST STE 1102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5447
Mailing Address - Country:US
Mailing Address - Phone:352-512-0092
Mailing Address - Fax:352-512-0093
Practice Address - Street 1:1740 SE 18TH ST STE 1102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5447
Practice Address - Country:US
Practice Address - Phone:352-512-0092
Practice Address - Fax:352-512-0093
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103625OtherMEDICAL LICENSE