MEDICARE: CAMERON LABELLE 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	390200000X	Student in an Organized Health Care Education/Training Program	390200000X	FL

General Provider Information

NPI Number	:	1780541151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON LABELLE TAYLOR PA-C

Provider Business Mailing Address
First Line	:	109 SWIMMING PEN DR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10870 US ONE N UNIT 104
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-7804
Country	:	US
Telephone Number	:	904-438-2720
Fax Number	:	904-212-1711

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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