Provider Demographics
NPI:1871865238
Name:FORINASH, STACI M (LPN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:FORINASH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3387
Mailing Address - Country:US
Mailing Address - Phone:863-993-4601
Mailing Address - Fax:863-491-7564
Practice Address - Street 1:34 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3387
Practice Address - Country:US
Practice Address - Phone:863-993-4601
Practice Address - Fax:863-491-7564
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5201811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN5201811OtherSTATE LICENSE