Provider Demographics
NPI:1689326886
Name:BERTONE, TAYLOR (NP-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BERTONE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9748 WILSON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9721
Mailing Address - Country:US
Mailing Address - Phone:330-204-3944
Mailing Address - Fax:
Practice Address - Street 1:1501 GOLDEN GATE PLZ
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3415
Practice Address - Country:US
Practice Address - Phone:440-499-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner