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NPI Code Detail

MEDICARE: STACEY FAGUE CRNP

MEDICARE: STACEY FAGUE CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner357616NY
2363LF0000XFamily Nurse PractitionerSP016266PA
3363LA2200XAdult Health Nurse PractitionerAPRN11044213FL

General Provider Information

NPI Number : 1487005724
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY FAGUE CRNP
Provider Business Mailing Address
First Line : 1 EMBARCADERO CTR STE 1900
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94111-3723
Country : US
Telephone Number : 888-663-6331
Fax Number :
Provider Business Practice Location Address
First Line : 489 5TH AVE FL 3
Second Line :
City : NEW YORK
State : NY
Zip : 10017-6145
Country : US
Telephone Number : 888-663-6331
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2016
Last Update Date : 03/18/2026

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