Provider Demographics
NPI:1831341965
Name:STEFFES, STACY GLASGOW
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:GLASGOW
Last Name:STEFFES
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 1:4480 DEERWOOD LAKE PKWY
Mailing Address - Street 2:#144
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2247
Mailing Address - Country:US
Mailing Address - Phone:904-928-9007
Mailing Address - Fax:
Practice Address - Street 1:6821 SOUTHPOINT DR N
Practice Address - Street 2:SUITE 217
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6267
Practice Address - Country:US
Practice Address - Phone:904-296-0979
Practice Address - Fax:904-926-0978
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist