Provider Demographics
NPI:1417093378
Name:TAYLOR, ANDREA JOY (DACM, AP)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JOY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DACM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14637 DURBIN ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7067
Mailing Address - Country:US
Mailing Address - Phone:585-469-0997
Mailing Address - Fax:
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 813
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5216
Practice Address - Country:US
Practice Address - Phone:904-701-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002439171100000X
FL3554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist