Provider Demographics
NPI:1447264338
Name:TAYLOR, NATASHA L (PA - C)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA - C
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Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:963 TOWN CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8254
Practice Address - Country:US
Practice Address - Phone:386-774-9880
Practice Address - Fax:386-774-2898
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 3277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
E3412XMedicare PIN