Provider Demographics
NPI:1194843359
Name:ISAACKS, STEPHANIE REBECCA (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REBECCA
Last Name:ISAACKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-1568
Mailing Address - Country:US
Mailing Address - Phone:409-651-4150
Mailing Address - Fax:
Practice Address - Street 1:296 US HIGHWAY BUSINESS 96
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612-0437
Practice Address - Country:US
Practice Address - Phone:409-994-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675337163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ45371Medicare UPIN
TX8D8340Medicare PIN