Provider Demographics
NPI:1700402187
Name:JARNAGIN, TAYLOR CAROLYN (RN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CAROLYN
Last Name:JARNAGIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 LAKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4582
Mailing Address - Country:US
Mailing Address - Phone:817-810-0660
Mailing Address - Fax:
Practice Address - Street 1:5001 CORAL CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-1832
Practice Address - Country:US
Practice Address - Phone:682-352-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX982438163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse