Healthcare Provider Details

I. General information

NPI: 1164988770
Provider Name (Legal Business Name): TAYLOR NICOLE BARGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

3650 S GLEBE RD UNIT 344
ARLINGTON VA
22202-2393
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8665
  • Fax:
Mailing address:
  • Phone: 305-332-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: