Provider Demographics
NPI:1427162189
Name:APPLETON, STACI (MD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:
Last Name:APPLETON
Suffix:
Gender:F
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170
Mailing Address - Country:US
Mailing Address - Phone:386-957-3999
Mailing Address - Fax:386-402-7920
Practice Address - Street 1:405 DOWNING ST
Practice Address - Street 2:C/O APPLETON INTERNAL MEDICINE
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7109
Practice Address - Country:US
Practice Address - Phone:386-957-3999
Practice Address - Fax:386-402-7920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67829207R00000X
FLME0067829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27109OtherBCBS
FL377693000Medicaid
FLP00402436Medicare PIN
FL27109XMedicare PIN
FLF11110Medicare UPIN
FL27109CMedicare PIN