Provider Demographics
NPI:1669622288
Name:MEYERS, STACY R (RN, MSN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
Last Name:MEYERS
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8426
Mailing Address - Country:US
Mailing Address - Phone:757-510-8048
Mailing Address - Fax:
Practice Address - Street 1:215 HOLLAND DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8426
Practice Address - Country:US
Practice Address - Phone:757-510-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9627153163W00000X
VA0001215422163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP1700XNursing Service ProvidersRegistered NursePerinatal