Provider Demographics
NPI:1003800616
Name:TAYLOR, PHYLLIS ANN (APNC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-0640
Mailing Address - Country:US
Mailing Address - Phone:931-507-1212
Mailing Address - Fax:931-507-1217
Practice Address - Street 1:8598 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2308
Practice Address - Country:US
Practice Address - Phone:731-364-5675
Practice Address - Fax:731-364-2870
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN104363363L00000X
TNAPN0000007153363L00000X
TN7153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I505902Medicare PIN