Healthcare Provider Details

I. General information

NPI: 1518845866
Provider Name (Legal Business Name): TAYLOR JORDAN VIGIL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

550 NEW MEXICO HIGHWAY 105
ROCIADA NM
87742-6002
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-9275
  • Fax:
Mailing address:
  • Phone: 505-948-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: