Provider Demographics
NPI:1447913835
Name:PENICK, TAYLOR (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PENICK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 N HILLS DR APT 116
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3169
Mailing Address - Country:US
Mailing Address - Phone:256-783-4772
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1167
Practice Address - Country:US
Practice Address - Phone:512-473-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily