Provider Demographics
NPI:1619958683
Name:HERSH, STACEY T (CRNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:T
Last Name:HERSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 JOHN MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1370
Mailing Address - Country:US
Mailing Address - Phone:703-534-7262
Mailing Address - Fax:
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:STE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-9101
Practice Address - Fax:301-681-3525
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000776163W00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD044363800Medicaid
MD224409ZAEMedicare PIN
MDG00121Medicare UPIN