Provider Demographics
NPI:1801363478
Name:TAYLOR, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E. SUNSET RD., #17 BLDG B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3508
Mailing Address - Country:US
Mailing Address - Phone:702-479-8809
Mailing Address - Fax:
Practice Address - Street 1:2700 E. SUNSET RD., #17 BLDG B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3508
Practice Address - Country:US
Practice Address - Phone:702-479-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7854PCS3374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide