Provider Demographics
NPI:1114236031
Name:TAYLOR, JOANNE (RPA-C)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 EAST TREMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460
Mailing Address - Country:US
Mailing Address - Phone:718-764-1662
Mailing Address - Fax:646-224-1320
Practice Address - Street 1:930 EAST TREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:718-860-1111
Practice Address - Fax:646-224-1320
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012235363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical