Healthcare Provider Details

I. General information

NPI: 1043929110
Provider Name (Legal Business Name): TAYLOR LYNN CHASE AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

IV. Provider business mailing address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-4252
  • Fax: 207-810-4980
Mailing address:
  • Phone: 207-563-4252
  • Fax: 207-810-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP221548
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP221548
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN66507
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: