Provider Demographics
NPI:1952021206
Name:PEREZ, STACY CAMERON (APRN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CAMERON
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:MICHELLE
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-621-0671
Mailing Address - Fax:
Practice Address - Street 1:3839 COUNTY ROAD 218
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5708
Practice Address - Country:US
Practice Address - Phone:904-282-5474
Practice Address - Fax:904-282-5824
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily