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NPI Code Detail

MEDICARE: MITCHELL D TAYLOR PA-C

MEDICARE: MITCHELL D 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
1363A00000XPhysician AssistantPA9103007FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA5786OTHERFLRAILROAD MEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21497748743OTHERFLGROUP NPI NUMBER / LRHSI

General Provider Information

NPI Number : 1598713083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL D TAYLOR PA-C
Provider Business Mailing Address
First Line : 3350 NW 53RD ST STE 102
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33309-6354
Country : US
Telephone Number : 866-816-7846
Fax Number : 954-458-2928
Provider Business Practice Location Address
First Line : 6001 VINELAND RD STE 116
Second Line :
City : ORLANDO
State : FL
Zip : 32819-7829
Country : US
Telephone Number : 866-816-7846
Fax Number : 954-458-2928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 04/22/2022

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Directions to “ MITCHELL D TAYLOR PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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