Provider Demographics
NPI:1306322177
Name:SPRINGER, STACIA ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:ELIZABETH
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:ELIZABETH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-3404
Practice Address - Country:US
Practice Address - Phone:260-481-2700
Practice Address - Fax:260-481-2838
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014239A363L00000X
OHIP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner