Provider Demographics
NPI:1831696111
Name:AUSTIN, STACEY ANNE (FNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:AUSTIN
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 1:1776 JOHN PAUL CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4472
Mailing Address - Country:US
Mailing Address - Phone:248-310-1712
Mailing Address - Fax:
Practice Address - Street 1:1915 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7244
Practice Address - Country:US
Practice Address - Phone:248-723-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily