Healthcare Provider Details

I. General information

NPI: 1780725556
Provider Name (Legal Business Name): STACY KAY FERRITER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY KAY DAVIS CRNA

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDEN VIEW CT #102
ENCINITAS CA
92024-2478
US

IV. Provider business mailing address

PO BOX 33865
SAN DIEGO CA
92163-3865
US

V. Phone/Fax

Practice location:
  • Phone: 760-783-0441
  • Fax: 760-635-5972
Mailing address:
  • Phone: 858-810-7200
  • Fax: 858-221-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3132
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: