Healthcare Provider Details

I. General information

NPI: 1679015903
Provider Name (Legal Business Name): TIAJUANA TAYLOR RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 WILLIAMSBURG AVE
JACKSONVILLE FL
32208-1745
US

IV. Provider business mailing address

6648 KANE CREEK DR
JACKSONVILLE FL
32244-3498
US

V. Phone/Fax

Practice location:
  • Phone: 904-765-2988
  • Fax:
Mailing address:
  • Phone: 904-887-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT13595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: