Healthcare Provider Details

I. General information

NPI: 1861320012
Provider Name (Legal Business Name): TAYLOR KING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR WOLFE PA-C

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 N HIMES AVE
TAMPA FL
33614-7097
US

IV. Provider business mailing address

525 NE 7TH ST APT 504
FORT LAUDERDALE FL
33304-3097
US

V. Phone/Fax

Practice location:
  • Phone: 813-393-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: