Healthcare Provider Details

I. General information

NPI: 1528736733
Provider Name (Legal Business Name): ELIZABETH ANN TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S 306
BIRMINGHAM AL
35205-1248
US

IV. Provider business mailing address

1372 CALASH AVE
BIRMINGHAM AL
35213-1221
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-187290
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: