MEDICARE: MRS. PATSY TAYLOR 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	363LG0600X	Gerontology Nurse Practitioner	APRN11004048	FL

General Provider Information

NPI Number	:	1265081517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATSY TAYLOR NP

Provider Business Mailing Address
First Line	:	8518 JULIA MARIE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-0412
Country	:	US
Telephone Number	:	904-612-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	8518 JULIA MARIE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-0412
Country	:	US
Telephone Number	:	904-612-6242
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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