Provider Demographics
NPI:1922518265
Name:FERGUSON, STACEY (FNP)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13760 N 93RD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4260
Mailing Address - Country:US
Mailing Address - Phone:480-698-1606
Mailing Address - Fax:480-605-2250
Practice Address - Street 1:13760 N 93RD AVE STE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4260
Practice Address - Country:US
Practice Address - Phone:480-698-1606
Practice Address - Fax:480-605-2250
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily