Provider Demographics
NPI:1417251562
Name:STYNE, STACIA STEVENS (ARNP)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:STEVENS
Last Name:STYNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 JUNIOR ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8000
Mailing Address - Country:US
Mailing Address - Phone:386-960-8282
Mailing Address - Fax:386-960-8280
Practice Address - Street 1:2505 JUNIOR ST
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8000
Practice Address - Country:US
Practice Address - Phone:386-960-8282
Practice Address - Fax:386-960-8280
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202364363L00000X
FL9202364363LP0200X
FLAPRN9202364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG808ZMedicare PIN