Provider Demographics
NPI:1790450906
Name:ANDERSON, TAYLOR (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SIERRA WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2913
Mailing Address - Country:US
Mailing Address - Phone:916-402-6144
Mailing Address - Fax:
Practice Address - Street 1:3111 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2456
Practice Address - Country:US
Practice Address - Phone:530-537-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant