Healthcare Provider Details

I. General information

NPI: 1235514977
Provider Name (Legal Business Name): TAYLOR HALUCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10244 S US HIGHWAY 1
PORT ST LUCIE FL
34952-5615
US

IV. Provider business mailing address

10244 S US HIGHWAY 1
PORT ST LUCIE FL
34952-5615
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-7676
  • Fax: 773-337-9034
Mailing address:
  • Phone: 772-337-7676
  • Fax: 773-337-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9285252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: