Provider Demographics
NPI:1073822771
Name:TAYLOR, ANNELLE C (NP-C, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNELLE
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3913
Mailing Address - Country:US
Mailing Address - Phone:718-991-0605
Mailing Address - Fax:
Practice Address - Street 1:871 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3913
Practice Address - Country:US
Practice Address - Phone:718-991-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305564363LA2200X, 363LP2300X
NY421000363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health