Healthcare Provider Details

I. General information

NPI: 1699498774
Provider Name (Legal Business Name): AMBER TAYLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER NICOLE SOLIS TAYLOR NP

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SPILLWAY RD
BRANDON MS
39047-6066
US

IV. Provider business mailing address

157 GREENFIELD RIDGE DR
BRANDON MS
39042-7019
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-5532
  • Fax: 601-992-5547
Mailing address:
  • Phone: 601-966-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number905510
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: