Provider Demographics
NPI:1194472365
Name:TAYLOR, TAMMARA RENEE
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14323 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4745
Mailing Address - Country:US
Mailing Address - Phone:734-444-6602
Mailing Address - Fax:734-444-6602
Practice Address - Street 1:14323 JACKSON ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4745
Practice Address - Country:US
Practice Address - Phone:734-444-6602
Practice Address - Fax:734-444-6602
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health