Provider Demographics
NPI:1639718679
Name:LOWE, STACEY PETRA (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:PETRA
Last Name:LOWE
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9468 SW 146TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1068
Mailing Address - Country:US
Mailing Address - Phone:305-776-5128
Mailing Address - Fax:
Practice Address - Street 1:9468 SW 146TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1068
Practice Address - Country:US
Practice Address - Phone:305-776-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2020-03-20
Deactivation Date:2019-12-21
Deactivation Code:
Reactivation Date:2020-03-20
Provider Licenses
StateLicense IDTaxonomies
FL11005119364SA2100X
FLAPRN11005119363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Single Specialty