Provider Demographics
NPI:1124040241
Name:TA TAYLOR ENTERPRISES, INC
Entity Type:Organization
Organization Name:TA TAYLOR ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-540-9918
Mailing Address - Street 1:3046 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7221
Mailing Address - Country:US
Mailing Address - Phone:239-540-9918
Mailing Address - Fax:239-540-9192
Practice Address - Street 1:3046 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 1A
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7221
Practice Address - Country:US
Practice Address - Phone:239-540-9918
Practice Address - Fax:239-540-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92674207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272932600Medicaid
FL01599YMedicare ID - Type Unspecified
FLI30177Medicare UPIN