Provider Demographics
NPI:1952760571
Name:NORIEGA, TAYLOR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 E NC 54
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-405-2040
Mailing Address - Fax:919-747-4195
Practice Address - Street 1:2222 E NC 54
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-405-2040
Practice Address - Fax:919-747-4195
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4108363A00000X
VA0110-005228363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant