Healthcare Provider Details

I. General information

NPI: 1447876602
Provider Name (Legal Business Name): STEPHANIE TAYLOR PREVIC FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 E RIVER RD STE 105
TUCSON AZ
85718-6586
US

IV. Provider business mailing address

825 N GRAND AVE STE 100
NOGALES AZ
85621-1061
US

V. Phone/Fax

Practice location:
  • Phone: 520-524-6565
  • Fax: 520-495-3477
Mailing address:
  • Phone: 520-761-2128
  • Fax: 520-281-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: