Provider Demographics
NPI:1063055838
Name:VACIANNA, STEPHANIE M (MSN FNP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:VACIANNA
Suffix:
Gender:F
Credentials:MSN FNP-C
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Mailing Address - Street 1:11355 US HWY 87 S
Mailing Address - Street 2:STE 2
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-9431
Mailing Address - Country:US
Mailing Address - Phone:210-201-4327
Mailing Address - Fax:949-437-2183
Practice Address - Street 1:11355 US HWY 87
Practice Address - Street 2:STE 2
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-1661
Practice Address - Country:US
Practice Address - Phone:210-201-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP143704363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner