Provider Demographics
NPI:1083244396
Name:TAYLOR, CLARE TUCKER (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:TUCKER
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3415
Mailing Address - Country:US
Mailing Address - Phone:470-550-9119
Mailing Address - Fax:
Practice Address - Street 1:371 E PACES FERRY RD NE STE 825
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3292
Practice Address - Country:US
Practice Address - Phone:404-314-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233032363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherCASH PAY SERVICES