Provider Demographics
NPI:1740342799
Name:TAYLOR, PHARA JOURDAN (MS RD LDN)
Entity type:Individual
Prefix:
First Name:PHARA
Middle Name:JOURDAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:PHARA
Other - Middle Name:
Other - Last Name:JOURDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LDN
Mailing Address - Street 1:402 NW LYNDHURST CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3440
Mailing Address - Country:US
Mailing Address - Phone:772-878-8227
Mailing Address - Fax:772-324-7863
Practice Address - Street 1:10570 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5606
Practice Address - Country:US
Practice Address - Phone:772-878-8227
Practice Address - Fax:772-324-7863
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5606133V00000X
FLND 5606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered