Provider Demographics
NPI:1043943822
Name:TROUBLEFIELD, STACEY RENEE (NP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:TROUBLEFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-622-2800
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3787
Practice Address - Country:US
Practice Address - Phone:562-622-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2025-07-10
Deactivation Date:2025-07-09
Deactivation Code:
Reactivation Date:2025-07-10
Provider Licenses
StateLicense IDTaxonomies
VA0024184631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024184631OtherVIRGINIA BOARD OF NURSING