Provider Demographics
NPI:1992382220
Name:KLEIN, TAYLOR ANNE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:ANNE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1019
Mailing Address - Country:US
Mailing Address - Phone:954-265-4325
Mailing Address - Fax:
Practice Address - Street 1:801 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1019
Practice Address - Country:US
Practice Address - Phone:954-265-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9116570OtherSTATE LICENSE