Individual
DR. STACIE QUINN FESSETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2835 W DE LEON ST, SUITE #101, TAMPA, FL 33609-4130
(813) 254-6592
(813) 254-3634
Mailing address
2835 W DE LEON ST, SUITE #101, TAMPA, FL 33609-4130
(813) 254-6592
(813) 254-3634
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3325
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65A03
BCBS
FL
01
—
CQ633Y
MEDICARE PTAN
—
01
—
CQ633Z
MEDIARE PTAN
FL
01
—
P00829933
RR MEDICARE
FL
Enumeration date
11/02/2007
Last updated
07/11/2011
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