Provider Demographics
NPI:1851929962
Name:TAYLOR, AMY ROBERSON (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROBERSON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3346
Mailing Address - Country:US
Mailing Address - Phone:478-231-4515
Mailing Address - Fax:
Practice Address - Street 1:902 20TH ST W
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3346
Practice Address - Country:US
Practice Address - Phone:478-231-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner