Healthcare Provider Details

I. General information

NPI: 1265718043
Provider Name (Legal Business Name): TRACIE TAYLOR NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 SURF AVE
LORAIN OH
44053-1545
US

IV. Provider business mailing address

3112 SURF AVE
LORAIN OH
44053-1545
US

V. Phone/Fax

Practice location:
  • Phone: 440-453-2116
  • Fax:
Mailing address:
  • Phone: 440-453-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TRACIE LYNETTE TAYLOR
Title or Position: LPN
Credential:
Phone: 440-453-2116