Provider Demographics
NPI:1720036395
Name:JOSLIN, STACEY ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:JOSLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:HEILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:SRHS BUSINESS OFFICE
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3817
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:551 GREENVILLE RD
Practice Address - Street 2:SRHS MERCER FAMILY MEDICINE CENTER
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5019
Practice Address - Country:US
Practice Address - Phone:724-662-4155
Practice Address - Fax:724-662-2352
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000217L363A00000X
PAMA001579L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06822Medicare UPIN
ST585251Medicare ID - Type Unspecified