Stacy Anne Petersen, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95007971 Issued in CA

Practice address

700 W 19TH St
Costa Mesa, CA 92627-3517

Phone

(949) 645-4646

NPI assigned

May 1, 2018

Last updated

Feb 26, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stacy Petersen Medical Group, P.C.

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1194677955
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1144719527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26791 ALISO CREEK RD",
            "address_2": "1018",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "92677",
            "telephone_number": "949-991-4172",
            "fax_number": "949-288-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W 19TH ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273517",
            "telephone_number": "949-645-4646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26791 Aliso Creek Rd",
            "address_2": "1018",
            "address_purpose": "LOCATION",
            "city": "Laguna Niguel",
            "state": "CA",
            "postal_code": "926774112",
            "country_code": "US",
            "telephone_number": "949-991-4172",
            "fax_number": "949-288-0429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "STACY",
        "middle_name": "ANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-01",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95007971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashika Pese
• Jan Phillip Pesigan, M.A.
• David Pesonen
• Scott Thomas Pestotnik, PHARM D
• Tonya Lynn Peters-Kammeraad, L.C.S.W., NCPSYA
• Susan Petersen, M.P.T
• Corey Peterson, DC
• Emily Pettis, APRN
• Paul Ceif Petty, D.C.
• Marjorie Ann Pezzoli

• Family Nurse Practitioner in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.