Provider Demographics
NPI:1477946549
Name:DE LEON, STACEY (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 N 10TH ST STE C2
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3890
Mailing Address - Country:US
Mailing Address - Phone:956-972-0093
Mailing Address - Fax:956-972-0094
Practice Address - Street 1:6316 N 10TH ST STE C2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3890
Practice Address - Country:US
Practice Address - Phone:956-972-0093
Practice Address - Fax:956-972-0094
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily