Provider Demographics
NPI:1568966885
Name:TAYLOR, JACOB (NP-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N STE 401
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8728
Mailing Address - Country:US
Mailing Address - Phone:205-620-0359
Mailing Address - Fax:205-620-9686
Practice Address - Street 1:1890 AL HIGHWAY 157 STE 420B
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0689
Practice Address - Country:US
Practice Address - Phone:205-620-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1144075363LF0000X
ALF01180216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily