Healthcare Provider Details

I. General information

NPI: 1144672528
Provider Name (Legal Business Name): STEPHANIE WYNNE NAGLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2371 OWEN ST
SANTA CLARA CA
95054-3212
US

IV. Provider business mailing address

2371 OWEN ST
SANTA CLARA CA
95054-3212
US

V. Phone/Fax

Practice location:
  • Phone: 408-708-0204
  • Fax:
Mailing address:
  • Phone: 408-708-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95079347
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: