Provider Demographics
NPI:1396366753
Name:TAYLOR, ANGEL (CNA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 SOLANDRA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7208
Mailing Address - Country:US
Mailing Address - Phone:904-947-1401
Mailing Address - Fax:
Practice Address - Street 1:6316 SOLANDRA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7208
Practice Address - Country:US
Practice Address - Phone:904-947-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL361999376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide