Provider Demographics
NPI:1588023675
Name:GARCIA, STACY M (APRN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 SPRING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4494
Mailing Address - Country:US
Mailing Address - Phone:812-288-8360
Mailing Address - Fax:812-288-8375
Practice Address - Street 1:443 SPRING ST STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4494
Practice Address - Country:US
Practice Address - Phone:812-288-8360
Practice Address - Fax:812-288-8375
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009996363LF0000X
IN71006073A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100410330Medicaid
KYP01617618OtherRAILROAD MEDICARE
IN201346830Medicaid
INP01609813OtherRAILROAD MEDICARE
000001009424OtherANTHEM
KY50105927OtherPASSPORT HEALTH PLAN
KY7100410330Medicaid
IN257640006Medicare PIN