Provider Demographics
NPI:1821649674
Name:MOCK, TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MOCK
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 1:841 HOSPITAL RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3699
Mailing Address - Country:US
Mailing Address - Phone:724-349-7820
Mailing Address - Fax:724-349-8816
Practice Address - Street 1:841 HOSPITAL RD STE 2300
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3699
Practice Address - Country:US
Practice Address - Phone:724-349-7820
Practice Address - Fax:724-349-8816
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060933363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty