Healthcare Provider Details

I. General information

NPI: 1063796076
Provider Name (Legal Business Name): JENNIFER TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 HIGHLAND BLVD
COATESVILLE PA
19320-5822
US

IV. Provider business mailing address

495 HIGHLAND BLVD
COATESVILLE PA
19320-5822
US

V. Phone/Fax

Practice location:
  • Phone: 410-570-1310
  • Fax:
Mailing address:
  • Phone: 610-384-9500
  • Fax: 610-384-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP026225
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberR176340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: