Provider Demographics
NPI:1326330507
Name:TAYLOR'S EXCEPTIONAL NURSE PRACTITIONER SERVICE, LLC
Entity Type:Organization
Organization Name:TAYLOR'S EXCEPTIONAL NURSE PRACTITIONER SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-848-6390
Mailing Address - Street 1:PO BOX 153109
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915
Mailing Address - Country:US
Mailing Address - Phone:239-848-6390
Mailing Address - Fax:
Practice Address - Street 1:841 SW 47TH TER #106
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914
Practice Address - Country:US
Practice Address - Phone:239-848-6390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2879292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV276ZMedicare PIN
FLEY457AMedicare PIN