Provider Demographics
NPI:1417289406
Name:TAYLOR, MONICA (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 OPITZ BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3346
Mailing Address - Country:US
Mailing Address - Phone:703-670-7600
Mailing Address - Fax:703-730-5124
Practice Address - Street 1:2000 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3306
Practice Address - Country:US
Practice Address - Phone:703-499-9144
Practice Address - Fax:703-497-0051
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168568363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health