Provider Demographics
NPI:1962657775
Name:SARTIN, TAYLOR ELISE (GCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:ELISE
Last Name:SARTIN
Suffix:
Gender:F
Credentials:GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12445 S 18TH CIR
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3663
Mailing Address - Country:US
Mailing Address - Phone:405-590-4546
Mailing Address - Fax:
Practice Address - Street 1:12445 S 18TH CIR
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3663
Practice Address - Country:US
Practice Address - Phone:405-590-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81421364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology