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General NPI Number Information
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NPI Number | 1457945487
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Entity Type | Individual
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Provider Name | HEATHER TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 02/20/2021
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Last Update Date | 02/20/2021
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Provider Practice Location Address
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Address Line | 2301 MOODY BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4427
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Country | US
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Telephone | 386-439-6271
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Fax |
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Provider Business Mailing Address
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Address Line | 348 CRESCENT KEY DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-2928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS50505
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License Number State | FL
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