Provider Demographics
NPI:1275011199
Name:TAYLOR, TINA MARIE
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46041 REED ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-8915
Mailing Address - Country:US
Mailing Address - Phone:734-231-7755
Mailing Address - Fax:734-981-5384
Practice Address - Street 1:46041 REED ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-8915
Practice Address - Country:US
Practice Address - Phone:734-231-7755
Practice Address - Fax:734-981-5384
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other