Provider Demographics
NPI:1811213598
Name:TAYLOR, MARISA JEAN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N PARKWAY
Mailing Address - Street 2:STE. C
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2812
Mailing Address - Country:US
Mailing Address - Phone:731-300-3099
Mailing Address - Fax:731-300-3163
Practice Address - Street 1:470 N PARKWAY
Practice Address - Street 2:STE. C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2812
Practice Address - Country:US
Practice Address - Phone:731-300-3099
Practice Address - Fax:731-300-3163
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily