Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA-48657 | FL |
NPI | 1538208509 |
---|---|
Provider Name | Ms. Jacquelyn Marie Stacy |
First Address | Tallahassee, FL 32311-4060 |
Second Address | Tallahassee, FL 32301-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |