Provider Demographics
NPI:1124129358
Name:PAPPAS, STACEY JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:JEANNE
Last Name:PAPPAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 PALM COAST PKWY NE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3886
Mailing Address - Country:US
Mailing Address - Phone:386-254-5146
Mailing Address - Fax:386-445-7464
Practice Address - Street 1:309 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3886
Practice Address - Country:US
Practice Address - Phone:386-254-5146
Practice Address - Fax:386-445-7464
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14404207Q00000X, 207QS0010X
FLME93828207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274079600Medicaid
FL274079600Medicaid
FLI45583Medicare UPIN