Provider Demographics
NPI:1215407960
Name:WHITE, TAYLOR HAINES (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:HAINES
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5752
Mailing Address - Country:US
Mailing Address - Phone:850-623-9787
Mailing Address - Fax:850-626-7512
Practice Address - Street 1:5907 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8278
Practice Address - Country:US
Practice Address - Phone:850-623-9787
Practice Address - Fax:850-626-7512
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111673363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9111673OtherLICENSE NUMBER