Provider Demographics
NPI:1619454428
Name:TAYLOR, STACIE KARENE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:STACIE
Middle Name:KARENE
Last Name:TAYLOR
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:405 SANIBELLE CIR UNIT 28
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7546
Mailing Address - Country:US
Mailing Address - Phone:619-405-4222
Mailing Address - Fax:619-671-6555
Practice Address - Street 1:446 ALTA RD STE 6100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92158-0001
Practice Address - Country:US
Practice Address - Phone:619-671-6546
Practice Address - Fax:671-671-6555
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14581363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical