Healthcare Provider Details

I. General information

NPI: 1780541151
Provider Name (Legal Business Name): CAMERON LABELLE TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 US ONE N UNIT 104
PONTE VEDRA BEACH FL
32081-7804
US

IV. Provider business mailing address

109 SWIMMING PEN DR
MIDDLEBURG FL
32068-6754
US

V. Phone/Fax

Practice location:
  • Phone: 904-438-2720
  • Fax: 904-212-1711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number390200000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: