Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacey McKinnon

Individual provider Family Nurse Practitioner · NPI 1053823112

Stacey McKinnon is a Nurse Practitioner in Daytona Beach, Florida. Qualified in 2017, 9 years ago. Practices with Vitalmd Group Holding LLC, a 532-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
9
Licensed in
FL
In the registry since
2017
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Practice location Address checks out

769 N Clyde Morris Blvd
Daytona Beach, FL 32114-1603
Phone: (386) 258-0123
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 9242649 (FL)

Record details

NPI number1053823112
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 30, 2017
Last updated in NPPESJune 3, 2025
Certification dateJune 3, 2025
Mailing address16 Abacus Ave, Ormond Beach, FL 32174-1047

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Vitalmd Group Holding Llc — 532 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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