MEDICARE: STEPHANIE TAYLOR PREVIC 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	242881	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447876602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE TAYLOR PREVIC FNP-BC

Provider Business Mailing Address
First Line	:	825 N GRAND AVE STE 100
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-1061
Country	:	US
Telephone Number	:	520-761-2128
Fax Number	:	520-281-1112

Provider Business Practice Location Address
First Line	:	2195 E RIVER RD STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6586
Country	:	US
Telephone Number	:	520-524-6565
Fax Number	:	520-495-3477

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	09/04/2025

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