Provider Demographics
NPI:1972185916
Name:TAYLOR, TEQUILA M
Entity Type:Individual
Prefix:
First Name:TEQUILA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16007 NELAMERE RD UPPR
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2211
Mailing Address - Country:US
Mailing Address - Phone:216-858-6725
Mailing Address - Fax:
Practice Address - Street 1:16007 NELAMERE RD UPPR
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2211
Practice Address - Country:US
Practice Address - Phone:216-858-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide