Provider Demographics
NPI:1295177848
Name:SPAKE, STACI KRISANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:KRISANN
Last Name:SPAKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:KRISANN
Other - Last Name:SPAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:441 MCALISTER RD, STE 2400
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092
Mailing Address - Country:US
Mailing Address - Phone:704-735-0511
Mailing Address - Fax:704-735-0544
Practice Address - Street 1:441 MCALISTER RD, STE 2400
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-735-0511
Practice Address - Fax:704-735-0544
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006345363LF0000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily