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1366922882
STACEY L SHAW
PORT ORANGE, FL
NPI
1366922882
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: FL 2878322)
Enumeration Date
2018-08-14
Last Update Date
2018-08-14
Business Address
STACEY L SHAW ARNP
1690 DUNLAWTON AVE STE 230
PORT ORANGE, FL 32127-8980
Phone number: 386-271-2273
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Mailing Address
STACEY L SHAW ARNP
1690 DUNLAWTON AVE
PORT ORANGE, FL 32127-8979
Phone number: 386-717-8323
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