MEDICARE: TARA PATRICK TAYLOR M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1093279804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA PATRICK TAYLOR M.S.

Provider Business Mailing Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	267-219-8654
Fax Number	:	904-781-8685

Provider Business Practice Location Address
First Line	:	2392 NORTH EDGEWOOD AVENUE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254
Country	:	US
Telephone Number	:	267-219-8654
Fax Number	:	904-781-8685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	09/04/2025

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