Individual
STACIA POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
930S HARBOR CITY BLVD 101, MELBOURNE, FL 32901-1901
(321) 752-1599
(321) 956-9907
Mailing address
930 S HARBOR CITY BLVD STE 101, MELBOURNE, FL 32901-1901
(321) 752-1599
(321) 956-9907
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME51873
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070007530
RAIL ROAD MEDICARE
—
05
—
373042500
—
FL
Enumeration date
03/01/2006
Last updated
12/29/2015
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