Healthcare Provider Details

I. General information

NPI: 1659098192
Provider Name (Legal Business Name): STACEY TAYLOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY MILLS

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25130 HANCOCK AVE UNIT 100
MURRIETA CA
92562-5969
US

IV. Provider business mailing address

1780 E FLORIDA AVE
HEMET CA
92544-4679
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-3113
  • Fax:
Mailing address:
  • Phone: 951-222-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: