Provider Demographics
NPI:1275100679
Name:CHEN, TAYLOR ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:CHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:KIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1361 VILLA WAY UNIT E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6597
Mailing Address - Country:US
Mailing Address - Phone:727-916-1492
Mailing Address - Fax:
Practice Address - Street 1:6440 W NEWBERRY RD STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4368
Practice Address - Country:US
Practice Address - Phone:352-333-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9114462363A00000X
VA0110008579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant