Provider Demographics
NPI:1962836726
Name:TAYLOR, TERESITA L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:L
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 1:205 E UNIVERSITY AVE STE 157
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6817
Mailing Address - Country:US
Mailing Address - Phone:512-868-9078
Mailing Address - Fax:512-819-0646
Practice Address - Street 1:205 E UNIVERSITY AVE STE 157
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6817
Practice Address - Country:US
Practice Address - Phone:512-868-9078
Practice Address - Fax:512-819-0646
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily