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Individual
STACEY L FAGUE
Active
Individual
STACEY L FAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
357616
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11044213
FL
363LF0000X
Family Nurse Practitioner
SP016266
PA
Other
Enumeration date
06/28/2016
Last updated
05/14/2026
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