Healthcare Provider Details

I. General information

NPI: 1851951131
Provider Name (Legal Business Name): CYNTHIA RENEE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 ROSS CARTER BLVD
DUFFIELD VA
24244-5117
US

IV. Provider business mailing address

198 ROSS CARTER BLVD
DUFFIELD VA
24244-5117
US

V. Phone/Fax

Practice location:
  • Phone: 276-690-7161
  • Fax: 276-690-7246
Mailing address:
  • Phone: 276-690-7161
  • Fax: 276-690-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001213961
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: