Healthcare Provider Details

I. General information

NPI: 1285042549
Provider Name (Legal Business Name): TAYLOR MAE TEMNICK EDD, LAT, ATC, CES,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 PARK BLVD
SEMINOLE FL
33777-4119
US

IV. Provider business mailing address

1745 S HIGHLAND AVE
CLEARWATER FL
33756-1852
US

V. Phone/Fax

Practice location:
  • Phone: 727-545-4545
  • Fax: 727-548-1360
Mailing address:
  • Phone: 727-587-0377
  • Fax: 727-548-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1068
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: