1710538590 NPI number — STACY SPINNER APRN

Table of content: STACY SPINNER APRN (NPI 1710538590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710538590 NPI number — STACY SPINNER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPINNER
Provider First Name:
STACY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOZEAT
Provider Other First Name:
STACY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710538590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 HUDSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34449-9783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2044 TRINITY OAKS BLVD
Provider Second Line Business Practice Location Address:
STE 125
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-376-0060
Provider Business Practice Location Address Fax Number:
866-551-6104
Provider Enumeration Date:
09/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN11001359 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104332900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com