Provider Demographics
NPI:1396264636
Name:PATRICK, STEFANIE M (FNP-C)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:M
Last Name:PATRICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 WINROW RD BLDG 45001
Mailing Address - Street 2:
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-5080
Mailing Address - Country:US
Mailing Address - Phone:520-533-9033
Mailing Address - Fax:520-533-5328
Practice Address - Street 1:2240 WINROW RD BLDG 45001
Practice Address - Street 2:
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:520-533-9033
Practice Address - Fax:520-833-5328
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017143899363LF0000X
AZ256196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily