Provider Information for 1588250153
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
STACEY DIOSELINA PEBBLER
Sex: Female
NPI: 1588250153
Last Updated: 2020-12-17
Certification Date: 2020-12-17
Certification Date: 2020-12-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1588250153 | ||||||||
| Enumeration Date | 2020-12-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2405 STANFORD RD APT 208 PANAMA CITY, FL 32405-3556 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 747 JENKS AVE STE D PANAMA CITY, FL 32401-2570 United States Phone: 813-290-8560 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|