MEDICARE: STEPHANIE WYNNE NAGLE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95079347	CA
2	363LF0000X	Family Nurse Practitioner	95006236	CA

General Provider Information

NPI Number	:	1144672528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WYNNE NAGLE FNP-BC

Provider Business Mailing Address
First Line	:	2371 OWEN ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-3212
Country	:	US
Telephone Number	:	408-708-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	2371 OWEN ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-3212
Country	:	US
Telephone Number	:	408-708-0204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	09/17/2025

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