Provider Demographics
NPI:1740555705
Name:TAYLOR, CRYSTAL L (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DARLING AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5223
Mailing Address - Country:US
Mailing Address - Phone:912-283-1717
Mailing Address - Fax:912-283-7633
Practice Address - Street 1:303 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5223
Practice Address - Country:US
Practice Address - Phone:912-283-1717
Practice Address - Fax:912-283-7633
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169794363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health