Provider Demographics
NPI:1437021219
Name:O'BRIEN, STACIE DEE
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:DEE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8915
Mailing Address - Country:US
Mailing Address - Phone:952-201-5375
Mailing Address - Fax:
Practice Address - Street 1:630 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-8915
Practice Address - Country:US
Practice Address - Phone:952-201-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI43685183500000X
FLRN9551683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183500000XPharmacy Service ProvidersPharmacist