Provider Demographics
NPI:1912697483
Name:PADDACK, STEPHANI (NP)
Entity type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:PADDACK
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 VERMEL AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4117
Mailing Address - Country:US
Mailing Address - Phone:317-523-4804
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY STE 207
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3628
Practice Address - Country:US
Practice Address - Phone:760-610-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016241A363L00000X
CA95025089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner