Provider Demographics
NPI:1235514977
Name:HALUCK, TAYLOR (APRN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HALUCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10244 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5615
Mailing Address - Country:US
Mailing Address - Phone:772-337-7676
Mailing Address - Fax:773-337-9034
Practice Address - Street 1:10244 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5615
Practice Address - Country:US
Practice Address - Phone:772-337-7676
Practice Address - Fax:773-337-9034
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9285252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily