Provider Demographics
NPI:1023338233
Name:TAYLOR, MARK RICHARD (ANRP, FNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ANRP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 NE MATSON ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8461
Mailing Address - Country:US
Mailing Address - Phone:360-626-3601
Mailing Address - Fax:
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW
Practice Address - Street 2:SUITE 102
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-779-4444
Practice Address - Fax:360-697-2514
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050082NP363LF0000X
WAAP60281164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily