Healthcare Provider Details

I. General information

NPI: 1548854573
Provider Name (Legal Business Name): ANTOINETTE LASHON TAYLOR NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax:
Mailing address:
  • Phone: 916-351-9400
  • Fax: 916-351-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: