Provider Demographics
NPI:1407173875
Name:TAYLOR, KELLY NANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NANETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3314 ROYAL ASCOT RUN
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5116
Mailing Address - Country:US
Mailing Address - Phone:407-294-9806
Mailing Address - Fax:978-285-5675
Practice Address - Street 1:2700 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2964
Practice Address - Country:US
Practice Address - Phone:407-654-2724
Practice Address - Fax:407-654-2793
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2014-04-08
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Provider Licenses
StateLicense IDTaxonomies
FLME69372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNA873480Medicaid