Healthcare Provider Details

I. General information

NPI: 1477421725
Provider Name (Legal Business Name): TAYLOR GRACE HARCUM REVEL CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 TILGHMAN RD
SALISBURY MD
21804-1921
US

IV. Provider business mailing address

1821 SWEETBAY DR STE 1
SALISBURY MD
21804-1664
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-4600
  • Fax:
Mailing address:
  • Phone: 443-944-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR245623
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: