Provider Demographics
NPI:1821652645
Name:TAYLOR, TRAVIA MONIQUE (APRN CNP)
Entity Type:Individual
Prefix:MRS
First Name:TRAVIA
Middle Name:MONIQUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8789
Mailing Address - Country:US
Mailing Address - Phone:216-224-6742
Mailing Address - Fax:
Practice Address - Street 1:254 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1620
Practice Address - Country:US
Practice Address - Phone:440-988-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily