Provider Demographics
NPI:1073917829
Name:STAGG, NICHOLAS SCOTT (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:STAGG
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7522
Mailing Address - Country:US
Mailing Address - Phone:928-704-1221
Mailing Address - Fax:928-704-1243
Practice Address - Street 1:2585 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7522
Practice Address - Country:US
Practice Address - Phone:928-704-1221
Practice Address - Fax:928-704-1243
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5811750363LF0000X
AZAP7427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily