Healthcare Provider Details

I. General information

NPI: 1013097328
Provider Name (Legal Business Name): EVANGELINE M TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE M JOHNSON

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ARLINGTON AVE
TOLEDO OH
43614-2688
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-812-2809
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003179RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: