MEDICARE: MRS. STACY LYNN TAYLOR FNP-C

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	363LF0000X	Family Nurse Practitioner	28150593A	IN
2	363LF0000X	Family Nurse Practitioner	71008563A	IN

General Provider Information

NPI Number	:	1225510951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LYNN TAYLOR FNP-C

Provider Business Mailing Address
First Line	:	701 CLOVER LN
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-2967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 E 10TH ST # STREET14
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-5313
Country	:	US
Telephone Number	:	219-945-9383
Fax Number	:	219-945-9384

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	01/06/2020

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