Provider Demographics
NPI:1528434479
Name:SUTTON, STACY (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 581
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4647
Mailing Address - Country:US
Mailing Address - Phone:407-303-2070
Mailing Address - Fax:407-303-2071
Practice Address - Street 1:2501 N ORANGE AVE STE 581
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4647
Practice Address - Country:US
Practice Address - Phone:407-303-2070
Practice Address - Fax:407-303-2071
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant