Provider Demographics
NPI:1578989281
Name:TAYLOR, JAYME ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:ELIZABETH
Other - Last Name:EWANICHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:WEST PAVILION, 4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2300
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:WEST PAVILION, 4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily