Provider Demographics
NPI:1013524776
Name:HARRELL, TAYLOR M (CRNA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:HARRELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 CR 673 # 15876
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-8358
Mailing Address - Country:US
Mailing Address - Phone:941-713-2280
Mailing Address - Fax:
Practice Address - Street 1:4602 CR 673 # 15876
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-8358
Practice Address - Country:US
Practice Address - Phone:941-713-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118599367500000X
FLRN9400589163W00000X
KY4004545367500000X
NC007308367500000X
TN31600367500000X
FLAPRN11010731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse