Provider Demographics
NPI:1710149315
Name:TAYLOR, REBECCA LILIAN (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LILIAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3504
Mailing Address - Country:US
Mailing Address - Phone:706-571-1661
Mailing Address - Fax:706-660-2699
Practice Address - Street 1:705 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3504
Practice Address - Country:US
Practice Address - Phone:706-571-1661
Practice Address - Fax:706-660-2699
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065010363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics