Healthcare Provider Details

I. General information

NPI: 1467169359
Provider Name (Legal Business Name): TANYA SUZETTE TAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA SUZETTE GLOVER-TAYLOR

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

213 SCOTISH DR
MIDDLETOWN DE
19709-8757
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-2511
  • Fax:
Mailing address:
  • Phone: 215-817-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberL1-0039130
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: