Provider Demographics
NPI:1083159818
Name:PRATT, STACY (ARNP FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR STE 304
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2264
Mailing Address - Country:US
Mailing Address - Phone:727-587-7100
Mailing Address - Fax:
Practice Address - Street 1:1345 W BAY DR STE 304
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2264
Practice Address - Country:US
Practice Address - Phone:727-587-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9367971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily