Provider Demographics
NPI:1952723058
Name:TAYLOR, SHATIKA EWIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHATIKA
Middle Name:EWIN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 QUECREEK CIR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6849
Mailing Address - Country:US
Mailing Address - Phone:615-355-5432
Mailing Address - Fax:
Practice Address - Street 1:309 QUECREEK CIR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6849
Practice Address - Country:US
Practice Address - Phone:615-355-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily