Provider Demographics
NPI:1184051120
Name:TAYLOR, TONYA DELANE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:DELANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BAYMEADOWS RD
Mailing Address - Street 2:APT#235
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-5178
Mailing Address - Country:US
Mailing Address - Phone:904-485-3297
Mailing Address - Fax:
Practice Address - Street 1:4500 BAYMEADOWS RD
Practice Address - Street 2:APT#235
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-5178
Practice Address - Country:US
Practice Address - Phone:904-485-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233283253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care