MEDICARE: TAYLOR B CARROLL APRN, CNP

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	363L00000X	Nurse Practitioner	209018245	IL
2	363LF0000X	Family Nurse Practitioner	209018245	IL

General Provider Information

NPI Number	:	1578048377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR B CARROLL APRN, CNP

Provider Business Mailing Address
First Line	:	215 E 1ST ST STE 212
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3175
Country	:	US
Telephone Number	:	815-285-5843
Fax Number	:	815-285-5846

Provider Business Practice Location Address
First Line	:	215 E 1ST ST STE 212
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3175
Country	:	US
Telephone Number	:	815-285-5843
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	12/04/2024

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