Provider Demographics
NPI:1609397835
Name:TAYLOR, JENNIFER MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:413 PARK MANOR RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1125
Mailing Address - Country:US
Mailing Address - Phone:757-927-2222
Mailing Address - Fax:
Practice Address - Street 1:1708 OLD DONATION PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3064
Practice Address - Country:US
Practice Address - Phone:757-419-3000
Practice Address - Fax:757-213-9377
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-005805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant