Provider Demographics
NPI:1285034546
Name:TAYLOR, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19333 HIGHWAY 59 N
Mailing Address - Street 2:STE #145
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4204
Mailing Address - Country:US
Mailing Address - Phone:281-540-5437
Mailing Address - Fax:
Practice Address - Street 1:19333 HIGHWAY 59 N
Practice Address - Street 2:STE #145
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4204
Practice Address - Country:US
Practice Address - Phone:281-540-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant