Healthcare Provider Details

I. General information

NPI: 1982137824
Provider Name (Legal Business Name): CHRISTOPHER TAYLOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINELLAS ST STE 325
CLEARWATER FL
33756-3320
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-298-6121
  • Fax: 727-298-6151
Mailing address:
  • Phone: 727-532-1355
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPAT9110290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: