Provider Demographics
NPI:1043929110
Name:CHASE, TAYLOR (AGACNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MCKAY RD
Mailing Address - Street 2:
Mailing Address - City:EDGECOMB
Mailing Address - State:ME
Mailing Address - Zip Code:04556-3325
Mailing Address - Country:US
Mailing Address - Phone:207-624-2694
Mailing Address - Fax:
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221548363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care