Provider Demographics
NPI:1316573173
Name:TAYLOR, LATARA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LATARA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14518 CHERRY LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5140
Mailing Address - Country:US
Mailing Address - Phone:904-200-8978
Mailing Address - Fax:
Practice Address - Street 1:14518 CHERRY LAKE DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5140
Practice Address - Country:US
Practice Address - Phone:904-629-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081153363LF0000X
FL11007178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily