=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508224999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATONYA TAYLOR APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2016
-----------------------------------------------------
Last Update Date | 09/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4651 SHERIDAN ST STE 270
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-989-6000
-----------------------------------------------------
Fax | 954-967-8962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4651 SHERIDAN ST STE 270
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-989-6000
-----------------------------------------------------
Fax | 954-967-8962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN9231542
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------