Provider Demographics
NPI:1609206523
Name:GUILLEN, STACIA (FNP-C)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 THORNGATE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1426
Mailing Address - Country:US
Mailing Address - Phone:714-642-6149
Mailing Address - Fax:
Practice Address - Street 1:364 MCLAWS CIR STE 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6340
Practice Address - Country:US
Practice Address - Phone:757-260-9974
Practice Address - Fax:877-505-4568
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA788745163W00000X
CA23757363LF0000X
VA0024178910363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily