Provider Demographics
NPI:1881155380
Name:ELLIS, TAYLOR BRYANT (APRN, FNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BRYANT
Last Name:ELLIS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8723
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:
Practice Address - Street 1:617 W MARION ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2421
Practice Address - Country:US
Practice Address - Phone:843-669-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily