Provider Demographics
NPI:1790231363
Name:PENCE ROBINSON, TAYLOR JADE (CAA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JADE
Last Name:PENCE ROBINSON
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JADE
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 SHADY CT
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-6277
Mailing Address - Country:US
Mailing Address - Phone:423-883-0330
Mailing Address - Fax:
Practice Address - Street 1:304 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5621
Practice Address - Country:US
Practice Address - Phone:706-509-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant