Provider Demographics
NPI:1629715909
Name:MCCORMICK, TAYLOR ERIN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ERIN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 22 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4050
Mailing Address - Country:US
Mailing Address - Phone:757-848-8652
Mailing Address - Fax:
Practice Address - Street 1:620 22 1/2 ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4050
Practice Address - Country:US
Practice Address - Phone:757-848-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program