Provider Demographics
NPI:1932927480
Name:BIJIMINE, STACY TSHIBOLA (AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:TSHIBOLA
Last Name:BIJIMINE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 WOODLAND HILLS DR APT 15
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2195
Mailing Address - Country:US
Mailing Address - Phone:734-355-6470
Mailing Address - Fax:
Practice Address - Street 1:3024 WOODLAND HILLS DR APT 15
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2195
Practice Address - Country:US
Practice Address - Phone:734-355-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704355249363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care