Provider Demographics
NPI:1023251352
Name:SAUER, STACY LEE (APRN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:SAUER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LEE
Other - Last Name:PUFAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:888-987-1151
Mailing Address - Fax:
Practice Address - Street 1:6363 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2373
Practice Address - Country:US
Practice Address - Phone:941-297-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9374315363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000612222OtherANTHEM
FL011914700Medicaid
IN200941300Medicaid
FL1023251352OtherTRICARE
FL011914700Medicaid
IN248130EMedicare PIN