Provider Demographics
NPI:1073625588
Name:TAYLOR, JANNINE GUNDERSEN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANNINE
Middle Name:GUNDERSEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANNINE
Other - Middle Name:GUNDERSEN
Other - Last Name:DERANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:115 SWEETWATER OAKS
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2110
Mailing Address - Country:US
Mailing Address - Phone:678-592-6633
Mailing Address - Fax:
Practice Address - Street 1:115 SWEETWATER OAKS
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2110
Practice Address - Country:US
Practice Address - Phone:678-592-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA145037367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered