Healthcare Provider Details

I. General information

NPI: 1750899217
Provider Name (Legal Business Name): TAYANNA GISELLE LAWLOR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 N CLYDE MORRIS BLVD STE 120
DAYTONA BEACH FL
32117-5519
US

IV. Provider business mailing address

1913 N CLYDE MORRIS BLVD STE 120
DAYTONA BEACH FL
32117-5519
US

V. Phone/Fax

Practice location:
  • Phone: 386-363-8300
  • Fax: 949-909-4420
Mailing address:
  • Phone: 386-363-8300
  • Fax: 949-909-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: