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Individual
STACY ELLIS
Active
Individual
STACY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R884850
MS
363LF0000X
Family Nurse Practitioner
Primary
176698
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17698
TN APN
TN
Enumeration date
04/23/2010
Last updated
11/04/2013
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