Provider Demographics
NPI:1528128733
Name:ROBINSON, STACEY J (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:ROBINSON
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 1:200 CENTRAL AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3567
Mailing Address - Country:US
Mailing Address - Phone:727-329-8859
Mailing Address - Fax:727-825-0330
Practice Address - Street 1:200 CENTRAL AVE STE 810
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3567
Practice Address - Country:US
Practice Address - Phone:727-329-8859
Practice Address - Fax:727-825-0330
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86818207P00000X, 207Q00000X
CAA64642207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00795Medicare UPIN