Provider Demographics
NPI:1073803201
Name:TAYLOR, TAICE AEISHA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TAICE
Middle Name:AEISHA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16926 SW 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-432-4186
Mailing Address - Fax:954-432-4186
Practice Address - Street 1:5000 W OAKLAND PARK
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:305-445-8461
Practice Address - Fax:305-441-6879
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9182188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00QNOtherBCBS
FLG00QNOtherBCBS
FLF0136XMedicare PIN