Healthcare Provider Details

I. General information

NPI: 1477460350
Provider Name (Legal Business Name): STACIA MARIE TYPPI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HAWTHORN DR
JACKSON MI
49201-7046
US

IV. Provider business mailing address

3620 HAWTHORN DR
JACKSON MI
49201-7046
US

V. Phone/Fax

Practice location:
  • Phone: 517-392-6881
  • Fax:
Mailing address:
  • Phone: 517-392-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08260916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: