Individual
KIMBERLY W STACKPOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 N CLYDE MORRIS BLVD, SUITE 320, DAYTONA BEACH, FL 32114-2781
(386) 255-5331
Mailing address
311 N CLYDE MORRIS BLVD, SUITE 320, DAYTONA BEACH, FL 32114-2781
(386) 255-5331
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
FL
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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