Provider Demographics
NPI:1063469849
Name:BAHNER, STACY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:BAHNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 W SETTLER DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2083
Mailing Address - Country:US
Mailing Address - Phone:352-527-3889
Mailing Address - Fax:352-527-3889
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:SEVEN RIVERS REGIONAL MEDICAL CENTER
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:352-795-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9173441367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47131Medicare UPIN