Provider Demographics
NPI:1710241260
Name:TAYLOR, JENNIFER HOPE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HOPE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:HOPE
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:74 ECLIPSE CTR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3550
Mailing Address - Country:US
Mailing Address - Phone:608-361-0311
Mailing Address - Fax:
Practice Address - Street 1:74 ECLIPSE CTR
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3550
Practice Address - Country:US
Practice Address - Phone:608-361-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364029003-61108-01Medicaid
IL5378720001OtherNGS - DME
IL146702Medicare PIN
IL364029003-61108-01Medicaid