Provider Demographics
NPI:1720658495
Name:ROOST, TAYLER
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:
Last Name:ROOST
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 1:7701 E OSBORN RD APT 57W
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7417
Mailing Address - Country:US
Mailing Address - Phone:209-912-9514
Mailing Address - Fax:
Practice Address - Street 1:7701 E OSBORN RD APT 57W
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7417
Practice Address - Country:US
Practice Address - Phone:209-912-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program