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General NPI Number Information
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NPI Number | 1609397835
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE TAYLOR PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1708 OLD DONATION PKWY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3064
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Country | US
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Telephone | 757-419-3000
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Fax | 757-213-9377
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Provider Business Mailing Address
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Address Line | 413 PARK MANOR RD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-1125
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Country | US
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Telephone | 757-927-2222
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-005805
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License Number State | VA
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