MEDICARE: ELIZETTE TAYLOR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	253Z00000X	In Home Supportive Care Agency	FL
2	372600000X	Adult Companion
3	3747P1801X	Personal Care Attendant	FL
4	376J00000X	Homemaker
5	385HR2065X	Child Physical Disabilities Respite Care
6	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215594585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZETTE TAYLOR

Provider Business Mailing Address
First Line	:	13441 ENGLISH PEAK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5502
Country	:	US
Telephone Number	:	904-345-1914
Fax Number	:	904-345-1914

Provider Business Practice Location Address
First Line	:	13441 ENGLISH PEAK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5502
Country	:	US
Telephone Number	:	904-345-1914
Fax Number	:

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “ ELIZETTE TAYLOR ” Practice Location

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