Provider Demographics
NPI:1750899217
Name:LAWLOR, TAYANNA GISELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TAYANNA
Middle Name:GISELLE
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FLORIDA MEMORIAL PKWY STE 2200
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9309
Mailing Address - Country:US
Mailing Address - Phone:386-409-6839
Mailing Address - Fax:386-409-6916
Practice Address - Street 1:125 FLORIDA MEMORIAL PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA
Practice Address - State:FL
Practice Address - Zip Code:32168-9309
Practice Address - Country:US
Practice Address - Phone:386-409-6839
Practice Address - Fax:386-409-6916
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00796000363LF0000X
FLAPRN11005002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty