Healthcare Provider Details

I. General information

NPI: 1336489442
Provider Name (Legal Business Name): ELBERT JAMAAL TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 BENJAMIN ROAD
TAMPA FL
33634
US

IV. Provider business mailing address

1903 W STATE ST
TAMPA FL
33606-1045
US

V. Phone/Fax

Practice location:
  • Phone: 813-880-0220
  • Fax:
Mailing address:
  • Phone: 813-500-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: