Provider Demographics
NPI:1801314281
Name:SANCHEZ, STACEY RENE (NP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:RENE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:8522 BROADWAY STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6456
Mailing Address - Country:US
Mailing Address - Phone:210-874-5260
Mailing Address - Fax:210-864-4838
Practice Address - Street 1:1902 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3554
Practice Address - Country:US
Practice Address - Phone:210-874-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP135014363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742728159OtherBUSINESS TAX ID
TX149471801OtherGROUP MEDICAID