Provider Demographics
NPI:1013502343
Name:TAYLOR, RANDAL TRENT (MSN, FNP-C, RN, EMTP)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:TRENT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MSN, FNP-C, RN, EMTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3606
Mailing Address - Country:US
Mailing Address - Phone:661-765-1935
Mailing Address - Fax:661-765-1928
Practice Address - Street 1:100 E NORTH ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3606
Practice Address - Country:US
Practice Address - Phone:661-765-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily