Provider Demographics
NPI:1649849639
Name:TAYLOR, NICOLE ASHLEY (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:667-214-1880
Mailing Address - Fax:410-685-1861
Practice Address - Street 1:29 SOUTH PACA ST FAMILY MEDICINE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:667-214-1880
Practice Address - Fax:410-685-1861
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-12-21
Deactivation Date:2022-12-08
Deactivation Code:
Reactivation Date:2022-12-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program