Provider Demographics
NPI:1508045949
Name:TUBRIDY, STACEY ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:TUBRIDY
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-4194
Practice Address - Fax:516-632-4195
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2015-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY501898367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01289617OtherRAILROAD MEDICARE
NYA400057588OtherEMPIRE MEDICARE