Provider Demographics
NPI:1083255731
Name:TAYLOR, DEANN T
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:T
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-2117
Mailing Address - Country:US
Mailing Address - Phone:727-645-7095
Mailing Address - Fax:
Practice Address - Street 1:5240 EAGLE DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-2117
Practice Address - Country:US
Practice Address - Phone:727-645-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764753Medicaid