Provider Demographics
NPI:1932258910
Name:CARANGELO, STACIE A (ANP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:CARANGELO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:A
Other - Last Name:KOZAKEWICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95 MADISON AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7336
Mailing Address - Country:US
Mailing Address - Phone:973-267-9400
Mailing Address - Fax:973-998-8805
Practice Address - Street 1:95 MADISON AVE STE 409
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7336
Practice Address - Country:US
Practice Address - Phone:973-267-9400
Practice Address - Fax:973-998-8805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303778-1363LA2200X
NJ26NJ00157600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health