Provider Demographics
NPI:1710005657
Name:TAYLOR, JESSE JR (RNFA)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6835
Mailing Address - Country:US
Mailing Address - Phone:719-238-2920
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:2412 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6835
Practice Address - Country:US
Practice Address - Phone:719-238-2920
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN117681163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant