Provider Demographics
NPI:1194554089
Name:STALLS, MADISON (DNP)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:STALLS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 JULINGTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2016
Mailing Address - Country:US
Mailing Address - Phone:904-482-6309
Mailing Address - Fax:
Practice Address - Street 1:108 BARTRAM OAKS WALK STE 201
Practice Address - Street 2:
Practice Address - City:FRUIT COVE
Practice Address - State:FL
Practice Address - Zip Code:32259-3246
Practice Address - Country:US
Practice Address - Phone:904-899-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily