Healthcare Provider Details

I. General information

NPI: 1164419024
Provider Name (Legal Business Name): JANE COLLERAN TAYLOR MSN,RN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13407 LYDIA ST
SILVER SPRING MD
20906-5225
US

IV. Provider business mailing address

9705 STIPP ST
BURKE VA
22015-4151
US

V. Phone/Fax

Practice location:
  • Phone: 301-929-5546
  • Fax: 301-929-5583
Mailing address:
  • Phone: 703-451-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR046298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: