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General NPI Number Information
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NPI Number | 1710653639
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Entity Type | Individual
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Provider Name | TAYLOR JETTON RUYAK AGACNP-BC, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 3200 CENTER VALLEY PKWY
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City | CENTER VALLEY
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State | PA
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Zip | 18034-9519
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Country | US
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Telephone | 610-242-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 CENTER VALLEY PKWY
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City | CENTER VALLEY
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State | PA
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Zip | 18034-9519
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Country | US
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Telephone | 610-242-0345
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 29989
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29989
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP028374
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License Number State | PA
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