Provider Demographics
NPI:1083090948
Name:BATISTIG, STACY LEA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEA
Last Name:BATISTIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LEA
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11116 MEDICAL CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13620 CRAYTON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2335
Practice Address - Country:US
Practice Address - Phone:240-313-3100
Practice Address - Fax:240-313-3101
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029443363LF0000X
MDR144742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily