Provider Demographics
NPI:1427454909
Name:FEEMSTER, STACY (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FEEMSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2507
Mailing Address - Country:US
Mailing Address - Phone:305-792-2090
Mailing Address - Fax:305-468-6324
Practice Address - Street 1:5735 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2507
Practice Address - Country:US
Practice Address - Phone:305-792-2090
Practice Address - Fax:305-468-6324
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002794363LF0000X
CANP95011256363LF0000X
FLARNP 9356006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily