Provider Demographics
NPI:1164744645
Name:TAFT, ALICE DIANE (WHNP)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:DIANE
Last Name:TAFT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38350 40TH ST E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3075
Mailing Address - Country:US
Mailing Address - Phone:661-726-6325
Mailing Address - Fax:661-726-6333
Practice Address - Street 1:38350 40TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3075
Practice Address - Country:US
Practice Address - Phone:661-726-6325
Practice Address - Fax:661-726-6333
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12142261QA0005X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility