Provider Demographics
NPI:1215434253
Name:HERNANDEZ, STACY ANN HARRIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN HARRIS
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2206 EXECUTIVE DR STE F
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2583
Practice Address - Country:US
Practice Address - Phone:757-825-1440
Practice Address - Fax:757-825-1587
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186270363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily