Provider Demographics
NPI:1205498508
Name:DURKEE, TAYLOR NICOLE
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:DURKEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAYLOR
Other - Middle Name:NICOLE
Other - Last Name:JACOPIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10829 W CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1006
Mailing Address - Country:US
Mailing Address - Phone:208-484-9238
Mailing Address - Fax:
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID49303163WC0200X
ID127429367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine