Provider Demographics
NPI:1386426450
Name:PAZIENZA, STACY GRACE
Entity type:Individual
Prefix:
First Name:STACY GRACE
Middle Name:
Last Name:PAZIENZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2017
Mailing Address - Country:US
Mailing Address - Phone:609-458-4273
Mailing Address - Fax:
Practice Address - Street 1:2786 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1306
Practice Address - Country:US
Practice Address - Phone:763-412-1993
Practice Address - Fax:888-972-8341
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998239-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily