Healthcare Provider Details

I. General information

NPI: 1679163489
Provider Name (Legal Business Name): IVY TAGGARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 MEDICAL CENTER DR E STE 309
CLOVIS CA
93611-6892
US

IV. Provider business mailing address

45 E RIVER PARK PL W STE 507
FRESNO CA
93720-1565
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: