Provider Demographics
NPI:1770881617
Name:FRASER, STEPHANIE FELICE (FNP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:FELICE
Last Name:FRASER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 MISTY PEAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4933
Mailing Address - Country:US
Mailing Address - Phone:904-866-5581
Mailing Address - Fax:
Practice Address - Street 1:23811 MISTY PEAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4933
Practice Address - Country:US
Practice Address - Phone:904-866-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX732985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily