Provider Demographics
NPI:1437835162
Name:ORNER, STACEY (RD, LD, MFN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:ORNER
Suffix:
Gender:F
Credentials:RD, LD, MFN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BOYLSTON CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0088
Mailing Address - Country:US
Mailing Address - Phone:216-650-2766
Mailing Address - Fax:
Practice Address - Street 1:62 BOYLSTON CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-0088
Practice Address - Country:US
Practice Address - Phone:216-650-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1091197133V00000X
FLND7649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered