MEDICARE: TAYLOR PERRY APRN

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	363LF0000X	Family Nurse Practitioner	11018957	FL

General Provider Information

NPI Number	:	1831839430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR PERRY APRN

Provider Business Mailing Address
First Line	:	5 MIRACLE STRIP LOOP
Second Line	:	UNIT 6
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-8410
Country	:	US
Telephone Number	:	850-238-8811
Fax Number	:	850-238-8868

Provider Business Practice Location Address
First Line	:	5 MIRACLE STRIP LOOP STE 6
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-8410
Country	:	US
Telephone Number	:	850-238-8811
Fax Number	:	850-238-8868

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	10/25/2024

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Directions to “ TAYLOR PERRY APRN” Practice Location

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