Provider Demographics
NPI:1205391356
Name:TAYLOR, ANTOINE VERNELL SR (NP)
Entity type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:VERNELL
Last Name:TAYLOR
Suffix:SR
Gender:M
Credentials:NP
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Mailing Address - Street 1:2920 TELEGRAPH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2031
Mailing Address - Country:US
Mailing Address - Phone:415-549-0212
Mailing Address - Fax:
Practice Address - Street 1:4550 VAN NUYS BLVD STE A4
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2844
Practice Address - Country:US
Practice Address - Phone:818-514-3631
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-01-09
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Provider Licenses
StateLicense IDTaxonomies
CA95010879207PE0004X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services