Healthcare Provider Details

I. General information

NPI: 1063055838
Provider Name (Legal Business Name): STEPHANIE M VACIANNA MSN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11355 US HWY 87 STE 2
ADKINS TX
78101-1661
US

IV. Provider business mailing address

11355 US HWY 87 S STE 2
ADKINS TX
78101-9431
US

V. Phone/Fax

Practice location:
  • Phone: 210-201-4327
  • Fax:
Mailing address:
  • Phone: 210-201-4327
  • Fax: 949-437-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP143704
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143704
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: