Provider Demographics
NPI:1699200162
Name:CARABIN, STACEY LYNN (APRN-CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:CARABIN
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:CARABIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP, LISW
Mailing Address - Street 1:2267 VILLAGE MALL DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-951-2020
Mailing Address - Fax:419-951-2020
Practice Address - Street 1:2267 VILLAGE MALL DR.
Practice Address - Street 2:SUITE 2
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-951-2020
Practice Address - Fax:419-951-2020
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031643363LP0808X
OHI.2002286104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker