Healthcare Provider Details

I. General information

NPI: 1033700729
Provider Name (Legal Business Name): CARSON AMBERBROOK TAYLOR M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CURIOSITY AVE
YULEE FL
32097-0036
US

IV. Provider business mailing address

550 CURIOSITY AVE
YULEE FL
32097-0036
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-3053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: