Provider Demographics
NPI:1679321970
Name:MILLS, STACY MAYRENE (APRN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MAYRENE
Last Name:MILLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17504 PRESERVE WALK LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3243
Mailing Address - Country:US
Mailing Address - Phone:813-549-2299
Mailing Address - Fax:
Practice Address - Street 1:17504 PRESERVE WALK LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3243
Practice Address - Country:US
Practice Address - Phone:813-549-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2748802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner