Provider Demographics
NPI:1720846462
Name:ALFORD, TAYLOR MACKENZIE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MACKENZIE
Last Name:ALFORD
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 1:4022 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-5783
Mailing Address - Country:US
Mailing Address - Phone:850-774-6153
Mailing Address - Fax:
Practice Address - Street 1:2930 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4408
Practice Address - Country:US
Practice Address - Phone:850-774-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program