Healthcare Provider Details

I. General information

NPI: 1619831229
Provider Name (Legal Business Name): TAYLOR KILPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SUNTREE BLVD STE 103A
MELBOURNE FL
32940-7540
US

IV. Provider business mailing address

656 EMERALD LAKE DR
COCOA FL
32926-4674
US

V. Phone/Fax

Practice location:
  • Phone: 321-757-4015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW22855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: