Provider Demographics
NPI:1780725556
Name:FERRITER, STACY KAY (CRNA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:KAY
Last Name:FERRITER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:KAY
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-810-7200
Mailing Address - Fax:858-221-5021
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:#102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-783-0441
Practice Address - Fax:760-635-5972
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN151771-2367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACRNA 3633OtherCA CRNA LICENSE
MN430005983Medicare PIN