Provider Demographics
NPI:1922437706
Name:TAYLOR, TERRENCE (DNP)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4515
Mailing Address - Country:US
Mailing Address - Phone:214-540-7727
Mailing Address - Fax:972-298-2429
Practice Address - Street 1:529W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4515
Practice Address - Country:US
Practice Address - Phone:214-540-7727
Practice Address - Fax:972-298-2429
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124581261QP2300X, 363L00000X, 363LA2100X, 363LP2300X
TX726423363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3527368-02Medicaid
TXAP124581OtherACNP LICENSE
TX726423OtherACNP LICENSE
TX435732YNJCMedicare PIN