Individual ProviderStacey JohnstonHospitalistAllopathic & Osteopathic PhysiciansPractice Address820 Prudential Dr Ste 304, Jacksonville, FL 32207(904) 202-3860(904) 202-1032PECOS EnrollmentBased on the most recent information from CMS, provider Stacey Johnston is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:21 AM.Profile DetailsProvider ID1144414368Provider TypeIndividualFull NameJohnston, StaceyTitleDr.CredentialMDGenderFemaleSole ProprietorNoEnumeration Date8/30/2007Last Updated10/24/2018Contact InformationPractice LocationPractice Address820 Prudential Dr Ste 304, Jacksonville, FL 32207Phone(904) 202-3860Fax(904) 202-3846Mailing LocationMailing AddressPO Box 44004, Jacksonville, FL 32231-4004Phone(904) 202-1032Fax(904) 376-4107Provider TaxonomiesCodeDescriptionLicenseCode208M00000XPrimaryDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicenseME137361FloridaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense001842GeorgiaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseME137361Florida