Provider Demographics
NPI:1659863405
Name:WOLF, TAYLOR BROOK (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:BROOK
Last Name:WOLF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JIMMY C VORHOFF JR DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4210
Mailing Address - Country:US
Mailing Address - Phone:337-349-5244
Mailing Address - Fax:
Practice Address - Street 1:1103 KALISTE SALOOM RD STE 204
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5784
Practice Address - Country:US
Practice Address - Phone:337-534-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily