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General NPI Number Information
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NPI Number | 1750649273
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Entity Type | Individual
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Provider Name | TAMARA DANIELLE TAYLOR ANP
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Gender | Female
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1120 S 6TH ST STE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63104-3602
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Country | US
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Telephone | 314-533-1871
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Fax | 314-261-9469
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Provider Business Mailing Address
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Address Line | 1120 S 6TH ST STE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63104-3602
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Country | US
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Telephone | 314-533-1871
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Fax | 314-261-9469
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2011023084
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License Number State | MO
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