{
"Npi": {
"NPI": "1609206523",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GUILLEN",
"FirstName": "STACIA",
"MiddleName": "NICHOLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4020 THORNGATE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILLIAMSBURG",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23188-1426",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-642-6149",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "825 DILIGENCE DR STE 226",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWPORT NEWS",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23606-4293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "855-940-4867",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/13/2013",
"LastUpdateDate": "01/16/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "0001293135",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "23757",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "0024178910",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "788745",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "C-APN.0105399-C-NP",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}