Provider Demographics
NPI:1669483939
Name:TAYLOR, STEPHANIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUMMIT ST
Mailing Address - Street 2:TRINITY COLLEGE HEALTH CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3100
Mailing Address - Country:US
Mailing Address - Phone:860-297-2018
Mailing Address - Fax:860-297-2020
Practice Address - Street 1:300 SUMMIT ST
Practice Address - Street 2:TRINITY COLLEGE HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3100
Practice Address - Country:US
Practice Address - Phone:860-297-2018
Practice Address - Fax:860-297-2020
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000900363L00000X
CT48708163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V4069OtherHEALTH NET
CT004238136Medicaid
CT090000OtherCONNECTICARE
CT400000900CT03OtherANTHEM
CT004238136Medicaid