MEDICARE: MRS. ALYSSA P TAYLOR FNP-BC

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	363LF0000X	Family Nurse Practitioner	26NJ01252300	NJ

General Provider Information

NPI Number	:	1760142871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSSA P TAYLOR FNP-BC

Provider Business Mailing Address
First Line	:	112 HARMONY RD
Second Line	:
City	:	MICKLETON
State	:	NJ
Zip	:	08056-1210
Country	:	US
Telephone Number	:	856-296-9798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	866-380-5874
Fax Number	:

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

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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