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General NPI Number Information
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NPI Number | 1780175158
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Entity Type | Individual
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Provider Name | MS. AJA ANTREA TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1300 CITIZENS BLVD STE 300
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City | LEESBURG
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State | FL
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Zip | 34748-3973
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Country | US
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Telephone | 352-323-0612
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Fax | 352-787-2386
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Provider Business Mailing Address
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Address Line | 1219 DUNN AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2405
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Country | US
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Telephone | 352-323-0612
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Fax | 352-787-2386
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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