Doctor Name: | STACIA D PETRANCOSTA |
NPI Number: | 1063735959 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 1722 Gruber Rd Fort Bragg, NC - 283107901 |
Business Phone Number: | 9105787053 |
Business Fax Number: | |
Mailing Address: | 3308 Harbour Pointe Pl Unit 8, FAYETTEVILLE |
State: | NC |
Postal Code: | 283141757 |
Phone Number: | 9105787053 |
Fax Number: | |
NPI Enumeration Date: | 03/05/2010 |
NPI Last Update Date: | 03/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |