Provider Demographics
NPI:1336792589
Name:SOARES, TAYLOR
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:SOARES
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 1:1554 S WATER ST STE B
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-4511
Mailing Address - Country:US
Mailing Address - Phone:904-877-1220
Mailing Address - Fax:904-877-1232
Practice Address - Street 1:1554 S WATER ST STE B
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4511
Practice Address - Country:US
Practice Address - Phone:904-877-1220
Practice Address - Fax:904-877-1232
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant