Healthcare Provider Details

I. General information

NPI: 1477931558
Provider Name (Legal Business Name): CHELSEA ANNE TAYLOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

PO BOX 3725
AUGUSTA GA
30914-3725
US

V. Phone/Fax

Practice location:
  • Phone: 855-863-9595
  • Fax: 706-868-8375
Mailing address:
  • Phone: 706-863-9595
  • Fax: 706-868-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: