MEDICARE: TAYLOR A LEARD 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	363AM0700X	Medical Physician Assistant	8238	GA
2	363AM0700X	Medical Physician Assistant	2563	SC
3	363A00000X	Physician Assistant	PA9110871	FL
4	363AM0700X	Medical Physician Assistant	PA9112017	FL

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	:	1366986861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR A LEARD PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1126 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-2920
Country	:	US
Telephone Number	:	904-432-3061
Fax Number	:	904-432-3062

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	03/03/2026

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Directions to “ TAYLOR A LEARD PA-C” Practice Location

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