Healthcare Provider Details

I. General information

NPI: 1659041861
Provider Name (Legal Business Name): NATHAN ANDREW TAYLOR AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 TAFT ST STE 200
PEMBROKE PINES FL
33026-4387
US

IV. Provider business mailing address

12301 TAFT ST STE 200
PEMBROKE PINES FL
33026-4387
US

V. Phone/Fax

Practice location:
  • Phone: 954-880-0090
  • Fax:
Mailing address:
  • Phone: 954-880-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: