Provider Demographics
NPI:1487182697
Name:HUGHES, STACEY ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ELIZABETH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:E
Other - Last Name:GERSHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3211 N OBRIEN PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1729
Mailing Address - Country:US
Mailing Address - Phone:517-505-2881
Mailing Address - Fax:
Practice Address - Street 1:500 S LIBERTY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-1924
Practice Address - Country:US
Practice Address - Phone:517-505-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015013A363LF0000X
GARN217846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily