Provider Demographics
NPI:1285153239
Name:VILLACORTA, STELLA KOCOVIC (DO)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:KOCOVIC
Last Name:VILLACORTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:KOCOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:800 E BROWARD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2020
Mailing Address - Country:US
Mailing Address - Phone:954-463-5406
Mailing Address - Fax:954-522-2456
Practice Address - Street 1:800 E BROWARD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2020
Practice Address - Country:US
Practice Address - Phone:954-463-5406
Practice Address - Fax:954-522-2456
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty