Provider Demographics
NPI:1124225818
Name:TAYLOR, MARILA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARILA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 LA POSTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1861
Mailing Address - Country:US
Mailing Address - Phone:915-929-6369
Mailing Address - Fax:915-581-7721
Practice Address - Street 1:8010 N LOOP DR STE 200-A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3226
Practice Address - Country:US
Practice Address - Phone:915-599-9844
Practice Address - Fax:915-581-7721
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ50631Medicare UPIN