Provider Demographics
NPI:1346755519
Name:TAYLOR, NICOLE MAE (LVN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 OLYMPIC PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1322
Mailing Address - Country:US
Mailing Address - Phone:254-269-2423
Mailing Address - Fax:
Practice Address - Street 1:2726 OLYMPIC PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1322
Practice Address - Country:US
Practice Address - Phone:254-269-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)