MEDICARE: DR. KELLY NANETTE TAYLOR M.D.

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	207Q00000X	Family Medicine Physician	ME69372	FL

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	:	1407173875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY NANETTE TAYLOR M.D.

Provider Business Mailing Address
First Line	:	3314 ROYAL ASCOT RUN
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5116
Country	:	US
Telephone Number	:	407-294-9806
Fax Number	:	978-285-5675

Provider Business Practice Location Address
First Line	:	2700 OLD WINTER GARDEN RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2964
Country	:	US
Telephone Number	:	407-654-2724
Fax Number	:	407-654-2793

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/08/2014

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