Provider Demographics
NPI:1467211821
Name:GHEZZI, STACY LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:GHEZZI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4868 MAPLE GROVE RD SE
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-1378
Mailing Address - Country:US
Mailing Address - Phone:330-340-1743
Mailing Address - Fax:
Practice Address - Street 1:110 DUBLIN DR STE A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7805
Practice Address - Country:US
Practice Address - Phone:330-364-8038
Practice Address - Fax:330-364-4732
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily