Provider Demographics
NPI:1649445974
Name:TAYLOR, VICKI LYNN (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 CEDARBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-4407
Mailing Address - Country:US
Mailing Address - Phone:850-969-1066
Mailing Address - Fax:850-969-0821
Practice Address - Street 1:9515 B HOLSBERRY ROAD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1668
Practice Address - Country:US
Practice Address - Phone:850-969-1066
Practice Address - Fax:850-969-0821
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 86176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7476OtherBLUE CROSS BLUE SHIELD