Individual
KORTNI STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1812 SW ALBERCA LN, PORT ST LUCIE, FL 34953-1667
(772) 336-7482
Mailing address
1812 SW ALBERCA LN, PORT ST LUCIE, FL 34953-1667
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5149519
FL
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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