Provider Demographics
NPI:1598488249
Name:TAYLOR, AUDREA LACEY LANDERS (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AUDREA
Middle Name:LACEY LANDERS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HAMPSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-9503
Mailing Address - Country:US
Mailing Address - Phone:931-580-2787
Mailing Address - Fax:
Practice Address - Street 1:401 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3357
Practice Address - Country:US
Practice Address - Phone:931-580-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner