Healthcare Provider Details

I. General information

NPI: 1396439634
Provider Name (Legal Business Name): TAYLOR WHITNEY AMBRUSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 7TH AVE N STE 107
SAINT PETERSBURG FL
33705-1348
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-6703
  • Fax: 727-894-1430
Mailing address:
  • Phone: 352-277-5305
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9488668
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11026838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: