Provider Demographics
NPI:1831837160
Name:TAYLOR, AGATHA ROSELINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:ROSELINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MEADOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4724
Mailing Address - Country:US
Mailing Address - Phone:732-991-4475
Mailing Address - Fax:
Practice Address - Street 1:1 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-584-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01305400363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care