Healthcare Provider Details

I. General information

NPI: 1558152397
Provider Name (Legal Business Name): TAYLOR WARR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5837
US

IV. Provider business mailing address

105 COMMERCIAL CENTER DR
RUSKIN FL
33573-6827
US

V. Phone/Fax

Practice location:
  • Phone: 505-596-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: