Provider Demographics
NPI:1467043661
Name:PACHECO, TAYLOR LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEIGH
Last Name:PACHECO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STACKHOUSE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1905
Mailing Address - Country:US
Mailing Address - Phone:508-496-7451
Mailing Address - Fax:
Practice Address - Street 1:45 DAN RD # 45
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2852
Practice Address - Country:US
Practice Address - Phone:781-867-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily