Provider Demographics
NPI:1184309528
Name:CRAYNE, STACY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:CRAYNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:KEENER-OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:224 MEMORIAL MEDICAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5111
Practice Address - Country:US
Practice Address - Phone:386-231-4060
Practice Address - Fax:386-615-9119
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027076363L00000X
FLAPRN11027076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119173300Medicaid