Provider Demographics
NPI:1588815559
Name:VELEZ, STACIE GONZALEZ (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:GONZALEZ
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7212 GB ALFORD HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7661
Mailing Address - Country:US
Mailing Address - Phone:919-552-1520
Mailing Address - Fax:919-552-8792
Practice Address - Street 1:7212 GB ALFORD HWY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7661
Practice Address - Country:US
Practice Address - Phone:919-552-1520
Practice Address - Fax:919-552-8792
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical