Provider Demographics
NPI:1699293118
Name:MANN, STACY MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:MANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:MCCOMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11129 CHERISSE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11129 CHERISSE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2098
Practice Address - Country:US
Practice Address - Phone:210-393-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily