Healthcare Provider Details

I. General information

NPI: 1497579049
Provider Name (Legal Business Name): TAYLOR RENAE GARCIA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ELM ST # 201
CALDWELL ID
83605-4857
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-2528
  • Fax: 208-375-2217
Mailing address:
  • Phone: 208-514-2500
  • Fax: 208-375-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP61628105
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1271066
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: