Provider Demographics
NPI:1821833914
Name:DEROSA, TAYLAR (SRNA)
Entity type:Individual
Prefix:
First Name:TAYLAR
Middle Name:
Last Name:DEROSA
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W CLAIBORNE RD APT 303
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3457
Mailing Address - Country:US
Mailing Address - Phone:443-553-9092
Mailing Address - Fax:
Practice Address - Street 1:655 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1512
Practice Address - Country:US
Practice Address - Phone:410-706-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR233080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse