Provider Demographics
NPI:1194196493
Name:TAYLOR, MOLLY (FNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 FOUNDERS LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3919
Mailing Address - Country:US
Mailing Address - Phone:217-243-0300
Mailing Address - Fax:
Practice Address - Street 1:15 FOUNDERS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3919
Practice Address - Country:US
Practice Address - Phone:217-243-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF0915815OtherAANP CERTIFICATION