Healthcare Provider Details

I. General information

NPI: 1912554817
Provider Name (Legal Business Name): TAYLOR PIONTEK NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2019
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 200
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

3240 E PINCHOT AVE UNIT 13
PHOENIX AZ
85018-6994
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-5330
  • Fax:
Mailing address:
  • Phone: 417-437-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230152
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: