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General NPI Number Information
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NPI Number | 1750961017
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Entity Type | Individual
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Provider Name | STACEY ANN SWINEHART CRNP-FAMILY
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 5046 HIGHWAY 17 BYP S STE 200
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-4503
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Country | US
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Telephone | 843-449-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 5046 HIGHWAY 17 BYP S STE 200
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-4503
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Country | US
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Telephone | 843-449-0453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R253460
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 351801
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 041.437483
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 29449
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License Number State | SC
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