Provider Demographics
NPI:1932850062
Name:TAYLOR JACKSON, MICHELAR NATOYA (NP)
Entity Type:Individual
Prefix:
First Name:MICHELAR
Middle Name:NATOYA
Last Name:TAYLOR JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELAR
Other - Middle Name:NATOYA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6328 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1639
Mailing Address - Country:US
Mailing Address - Phone:701-781-2290
Mailing Address - Fax:
Practice Address - Street 1:6328 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1639
Practice Address - Country:US
Practice Address - Phone:701-781-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily