Provider Demographics
NPI:1972789675
Name:TAYLOR, KARYN DENISE (PA-C, AA-C)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:DENISE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C, AA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DENISE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6205 LONNIE LEE LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1331
Mailing Address - Country:US
Mailing Address - Phone:813-335-8020
Mailing Address - Fax:
Practice Address - Street 1:2165 HERSCHEL ST
Practice Address - Street 2:CARE OF NFAC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3819
Practice Address - Country:US
Practice Address - Phone:904-387-4030
Practice Address - Fax:904-381-9808
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104457363AS0400X
FLAA164367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000880400Medicaid
FL000880400Medicaid