Provider Demographics
NPI:1164496584
Name:TAYLOR, JACQUELINE ANN (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:SUE WAH SING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5130 SUNFOREST DR
Mailing Address - Street 2:STE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:813-689-9900
Mailing Address - Fax:813-653-9696
Practice Address - Street 1:5534 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:941-757-2100
Practice Address - Fax:941-757-2101
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275470700Medicaid
FL275470700Medicaid
FLU4968ZMedicare ID - Type Unspecified
FLH75563Medicare UPIN