Provider Demographics
NPI:1447378203
Name:STANSELL, TONI-ANN
Entity type:Individual
Prefix:MRS
First Name:TONI-ANN
Middle Name:
Last Name:STANSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 BRUNELLO TRCE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-7800
Mailing Address - Country:US
Mailing Address - Phone:727-834-5428
Mailing Address - Fax:813-949-7535
Practice Address - Street 1:2433 BRUNELLO TRCE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-7800
Practice Address - Country:US
Practice Address - Phone:727-834-5428
Practice Address - Fax:813-949-7535
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL755208400Medicaid