Provider Demographics
NPI:1083758932
Name:TAYLOR, CANDICE D (RN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-0670
Mailing Address - Country:US
Mailing Address - Phone:731-658-5291
Mailing Address - Fax:731-658-6536
Practice Address - Street 1:10825 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3599
Practice Address - Country:US
Practice Address - Phone:731-658-5291
Practice Address - Fax:731-658-6536
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000150057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse