Provider Demographics
NPI:1568458909
Name:HOWARD, STACI DAWN (CRNA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:DAWN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7758 BEAVER HEAD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5421
Mailing Address - Country:US
Mailing Address - Phone:817-485-3521
Mailing Address - Fax:
Practice Address - Street 1:1900 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2002
Practice Address - Country:US
Practice Address - Phone:940-665-8536
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9769Medicare ID - Type Unspecified