Provider Demographics
NPI:1992753677
Name:ORELLANA, STACEY OSLIE (ARNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:OSLIE
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:ATTN: UROLOGY (112C)
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-548-6175
Mailing Address - Fax:352-548-6555
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:ATTN: UROLOGY (112C)
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-548-6175
Practice Address - Fax:352-548-6555
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9209869363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307985600Medicaid
FLY113LOtherBCBS