Provider Demographics
NPI:1538768098
Name:STAMATOPOULOS, HRISTOS (PA-C)
Entity type:Individual
Prefix:
First Name:HRISTOS
Middle Name:
Last Name:STAMATOPOULOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8701
Mailing Address - Country:US
Mailing Address - Phone:772-460-9227
Mailing Address - Fax:772-460-9292
Practice Address - Street 1:5550 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8701
Practice Address - Country:US
Practice Address - Phone:772-460-9227
Practice Address - Fax:772-460-9292
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116714363A00000X
SC3801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1179383OtherNCCPA