Provider Demographics
NPI:1609284983
Name:SHELTON, STACEY (ARNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:1201 MONUMENT RD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7428
Practice Address - Country:US
Practice Address - Phone:904-727-5151
Practice Address - Fax:904-727-5180
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9266322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013900000Medicaid
FLY0P75OtherBCBS
FLL2312OtherMEDICARE
FLARNP9266322OtherFL DOH