Provider Demographics
NPI:1881988871
Name:WILKIN, STACIA LYNNE (MSW)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:LYNNE
Last Name:WILKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CALIFORNIA WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-8826
Mailing Address - Country:US
Mailing Address - Phone:407-420-7300
Mailing Address - Fax:
Practice Address - Street 1:780 CALIFORNIA WOODS CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-8826
Practice Address - Country:US
Practice Address - Phone:407-733-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1Medicaid