Provider Demographics
NPI:1346243987
Name:TURSI, STACEY LUISE (NP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LUISE
Last Name:TURSI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BELLE TERRE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-474-6971
Mailing Address - Fax:631-476-7710
Practice Address - Street 1:200 BELLE TERRE RD
Practice Address - Street 2:DEPT. OF NURSING EDUCATION
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-474-6971
Practice Address - Fax:631-476-7710
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3011391363LA2200X
NYF301139363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS45780Medicare UPIN
91V541Medicare PIN