Healthcare Provider Details

I. General information

NPI: 1366388514
Provider Name (Legal Business Name): VICKI CASSANDRA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 NE 13TH DR
GAINESVILLE FL
32609-2403
US

IV. Provider business mailing address

3803 NE 13TH DR
GAINESVILLE FL
32609-2403
US

V. Phone/Fax

Practice location:
  • Phone: 352-219-1582
  • Fax:
Mailing address:
  • Phone: 352-219-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License NumberT327200960000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: