Healthcare Provider Details

I. General information

NPI: 1649924671
Provider Name (Legal Business Name): TAYLOR CAROLINE BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR BURGESS CALDARO

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 SHIPYARD BLVD
WILMINGTON NC
28403-6148
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax:
Mailing address:
  • Phone: 910-332-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001013109
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: