Healthcare Provider Details

I. General information

NPI: 1376355628
Provider Name (Legal Business Name): TAYLOR LOUISE TALLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY STE 670
ANNAPOLIS MD
21401-3277
US

IV. Provider business mailing address

2000 MEDICAL PKWY STE 409
ANNAPOLIS MD
21401-3746
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1150
  • Fax: 410-224-0065
Mailing address:
  • Phone: 443-481-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR234226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: