Healthcare Provider Details

I. General information

NPI: 1225642580
Provider Name (Legal Business Name): LAURA TAYLOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 WALDEMERE ST FL 6
SARASOTA FL
34239-2922
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8383
  • Fax: 941-917-8930
Mailing address:
  • Phone: 941-917-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025210-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: