Provider Demographics
NPI:1962900431
Name:BATES, STACEY LYNN (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:BATES
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3735 SE 56TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-1334
Mailing Address - Country:US
Mailing Address - Phone:352-209-4010
Mailing Address - Fax:
Practice Address - Street 1:1834 SW 1ST AVE STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8101
Practice Address - Country:US
Practice Address - Phone:352-732-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9273134363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care