MEDICARE: MARILA TAYLOR FNP-BC

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	363LF0000X	Family Nurse Practitioner	551784	TX

General Provider Information

NPI Number	:	1124225818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILA TAYLOR FNP-BC

Provider Business Mailing Address
First Line	:	6208 LA POSTA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1861
Country	:	US
Telephone Number	:	915-929-6369
Fax Number	:	915-581-7721

Provider Business Practice Location Address
First Line	:	8010 N LOOP DR STE 200-A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-3226
Country	:	US
Telephone Number	:	915-599-9844
Fax Number	:	915-581-7721

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	11/02/2011

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