Provider Demographics
NPI:1740377050
Name:TAYLOR, GINGER (APRN)
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD PARK LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2507
Mailing Address - Country:US
Mailing Address - Phone:860-355-3728
Mailing Address - Fax:860-355-4253
Practice Address - Street 1:1 OLD PARK LANE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-3728
Practice Address - Fax:860-355-4253
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363LF0000X363LF0000X
CT000613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004222816Medicaid
CTS94299Medicare UPIN
CTC01692Medicare ID - Type Unspecified
CT004222816Medicaid