Provider Demographics
NPI:1477047181
Name:LANE, TAYLOR ELAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:ELAINE
Last Name:LANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 SEMORAN DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8203
Mailing Address - Country:US
Mailing Address - Phone:850-982-6909
Mailing Address - Fax:
Practice Address - Street 1:4901 MARKETPLACE ROAD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8986
Practice Address - Country:US
Practice Address - Phone:850-484-4080
Practice Address - Fax:850-484-8113
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant