Provider Demographics
NPI:1700812690
Name:EDWARDS, STACY L (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-726-8871
Mailing Address - Fax:727-726-4943
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-726-8871
Practice Address - Fax:727-726-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0001713OtherUHC
FL123421OtherHUMANA
FL257297OtherAVMED
FL20886OtherBCBS
FL0161979008OtherCIGNA
FL0412595OtherUHC
FL5580758OtherAETNA
FL0412595OtherUHC
FL123421OtherHUMANA