Provider Demographics
NPI:1740788413
Name:SWINEA, TAYLOR S (ARNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:S
Last Name:SWINEA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615A PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4724
Mailing Address - Country:US
Mailing Address - Phone:912-548-0710
Mailing Address - Fax:912-548-0071
Practice Address - Street 1:615A PENDLETON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4724
Practice Address - Country:US
Practice Address - Phone:912-548-0710
Practice Address - Fax:912-548-0071
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235821363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology