Provider Demographics
NPI:1982352530
Name:CHANILLO, TAYLORE (NP, APRN, FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:TAYLORE
Middle Name:
Last Name:CHANILLO
Suffix:
Gender:F
Credentials:NP, APRN, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1932
Mailing Address - Country:US
Mailing Address - Phone:908-642-8267
Mailing Address - Fax:
Practice Address - Street 1:3 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1932
Practice Address - Country:US
Practice Address - Phone:908-642-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01281300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR18877800OtherRN