Provider Demographics
NPI:1043395148
Name:TAYLOR, SHARI ANN
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARISSA
Other - Middle Name:ANN
Other - Last Name:SPINOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4050 LONESOME RD STE A
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7085
Mailing Address - Country:US
Mailing Address - Phone:985-246-2600
Mailing Address - Fax:985-246-2601
Practice Address - Street 1:4050 LONESOME RD STE A
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7085
Practice Address - Country:US
Practice Address - Phone:985-246-2600
Practice Address - Fax:985-246-2601
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1195031Medicaid