Healthcare Provider Details

I. General information

NPI: 1407173875
Provider Name (Legal Business Name): KELLY NANETTE TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 OLD WINTER GARDEN RD
OCOEE FL
34761-2964
US

IV. Provider business mailing address

3314 ROYAL ASCOT RUN
GOTHA FL
34734-5116
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-2724
  • Fax: 407-654-2793
Mailing address:
  • Phone: 407-294-9806
  • Fax: 978-285-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME69372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: