Provider Demographics
NPI:1720036395
Name:JOSLIN, STACEY ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:JOSLIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:HEILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5000
Mailing Address - Fax:
Practice Address - Street 1:551 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5019
Practice Address - Country:US
Practice Address - Phone:724-662-4155
Practice Address - Fax:724-662-2352
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001579L363AM0700X
PAOA000217L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06822Medicare UPIN
ST585251Medicare ID - Type Unspecified