Provider Demographics
NPI:1396300067
Name:STIEGLER, KELCIE
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:
Last Name:STIEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29108 RIVERGATE RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6546
Mailing Address - Country:US
Mailing Address - Phone:813-919-9380
Mailing Address - Fax:
Practice Address - Street 1:6201 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4305
Practice Address - Country:US
Practice Address - Phone:352-265-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant