Provider Demographics
NPI:1508840364
Name:TAYLOR, MARIE L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440
Mailing Address - Country:US
Mailing Address - Phone:843-527-4442
Mailing Address - Fax:843-527-4027
Practice Address - Street 1:1075 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-527-4442
Practice Address - Fax:843-527-4027
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN144363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1371Medicaid
SC428958OtherRURAL HEALTH CMS
SCRHC132Medicaid
S783285078Medicare ID - Type Unspecified
S78328Medicare UPIN