So, I reinstalled the new NVidia drivers and swapped to DX9. The issues became IMMEDIATELY visible. Didn't even have to wait. Rebooted the system and same results. So, I swapped back to DX11 and reduced the resolution to QHD border-less window instead of 4k border-less window mode. So far there are NO stutter issues that I have seen. I'm going to try to run something heavy and see if I can get it to happen.

I really believe that FFXIV simply does not like any NVidia graphics driver past 3/28/18 when running in 4k mode. Go back to 3/28/18 and everything works great.. however, the drivers are so dated now that newer things don't work at all or don't work properly (nvidia shield for example).