Healthcare Provider Details

I. General information

NPI: 1962836726
Provider Name (Legal Business Name): TERESITA L. TAYLOR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E UNIVERSITY AVE STE 157
GEORGETOWN TX
78626-6817
US

IV. Provider business mailing address

205 E UNIVERSITY AVE STE 157
GEORGETOWN TX
78626-6817
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-9078
  • Fax: 512-819-0646
Mailing address:
  • Phone: 512-868-9078
  • Fax: 512-819-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number700056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: