Healthcare Provider Details

I. General information

NPI: 1609206523
Provider Name (Legal Business Name): STACIA NICHOLE GUILLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DILIGENCE DR STE 226
NEWPORT NEWS VA
23606-4293
US

IV. Provider business mailing address

4020 THORNGATE DR
WILLIAMSBURG VA
23188-1426
US

V. Phone/Fax

Practice location:
  • Phone: 855-940-4867
  • Fax:
Mailing address:
  • Phone: 714-642-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178910
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0105399-C-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23757
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001293135
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number788745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: