Provider Demographics
NPI:1871259184
Name:CAZEAU, STACY (FNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CAZEAU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 W 250 N STE 1
Mailing Address - Street 2:
Mailing Address - City:MARRIOTT SLATERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9234
Mailing Address - Country:US
Mailing Address - Phone:801-689-2647
Mailing Address - Fax:
Practice Address - Street 1:1920 W 250 N STE 1
Practice Address - Street 2:
Practice Address - City:MARRIOTT SLATERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-9234
Practice Address - Country:US
Practice Address - Phone:801-689-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8672604-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily