Provider Demographics
NPI:1942668751
Name:STAFFORD, STACY (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-664-2135
Mailing Address - Fax:
Practice Address - Street 1:8 CENTURY PINES DR STE 2
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-3732
Practice Address - Country:US
Practice Address - Phone:603-664-2135
Practice Address - Fax:603-664-9128
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3103418Medicaid