Healthcare Provider Details

I. General information

NPI: 1336540459
Provider Name (Legal Business Name): ROSE LEA TAYLOR ACNP, PMHNP, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W 2ND ST STE 21
MESA AZ
85201-6552
US

IV. Provider business mailing address

245 W 2ND ST STE 21
MESA AZ
85201-6552
US

V. Phone/Fax

Practice location:
  • Phone: 602-743-5561
  • Fax: 833-664-4074
Mailing address:
  • Phone: 602-743-5561
  • Fax: 833-664-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP7283
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP7283
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7283
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP7283
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP7283
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP7283
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: