MEDICARE: KATIE E TAYLOR PA-C

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	363A00000X	Physician Assistant
2	363AS0400X	Surgical Physician Assistant	PA9120472	FL

General Provider Information

NPI Number	:	1285522367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE E TAYLOR PA-C

Provider Business Mailing Address
First Line	:	240 N WICKHAM RD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8663
Country	:	US
Telephone Number	:	321-541-1777
Fax Number	:	321-541-1787

Provider Business Practice Location Address
First Line	:	240 N WICKHAM RD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8663
Country	:	US
Telephone Number	:	321-541-1777
Fax Number	:	321-541-1787

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	01/16/2026

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Directions to “ KATIE E TAYLOR PA-C” Practice Location

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