Provider Demographics
NPI:1821142746
Name:TAGGART, SYLVIA G (CRNA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:G
Last Name:TAGGART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OCEAN GREENS LN
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8457
Mailing Address - Country:US
Mailing Address - Phone:910-201-1356
Mailing Address - Fax:
Practice Address - Street 1:5301 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6510
Practice Address - Country:US
Practice Address - Phone:910-452-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC043758367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2607421Medicare ID - Type Unspecified