Individual
STACY TWIGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1827 HARRISON AVE, PANAMA CITY, FL 32405-7605
(850) 785-4344
(850) 785-6568
Mailing address
1827 HARRISON AVE, PANAMA CITY, FL 32405-7605
(850) 785-4344
(850) 785-6568
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085001809
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209118
MEDICARE PTAN LOCALITY 15
IL
01
—
209119
MEDICARE PTAN LOCALITY 16
IL
Enumeration date
05/22/2006
Last updated
07/01/2024
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