Provider Demographics
NPI:1134545692
Name:BARTMAN, STACIE POLLOCK
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:POLLOCK
Last Name:BARTMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5005
Mailing Address - Country:US
Mailing Address - Phone:843-651-8975
Mailing Address - Fax:
Practice Address - Street 1:3710 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-651-8975
Practice Address - Fax:843-651-0161
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013510363LF0000X
SC22351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily