MEDICARE: TAYLER GREEN NP

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	363LA2100X	Acute Care Nurse Practitioner	APN.0999010-NP	CO
2	363LG0600X	Gerontology Nurse Practitioner	APN.0999010-NP	CO

General Provider Information

NPI Number	:	1114608221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLER GREEN NP

Provider Business Mailing Address
First Line	:	1625 MEDICAL CENTER PT STE 240
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-960-0363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER PT STE 240
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-960-0363
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	02/16/2026

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