Provider Demographics
NPI:1447373345
Name:TAYLOR, TWILIA KAY
Entity type:Individual
Prefix:
First Name:TWILIA
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TWILIA
Other - Middle Name:KAY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:662 RIDGE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9526
Mailing Address - Country:US
Mailing Address - Phone:850-682-7114
Mailing Address - Fax:
Practice Address - Street 1:662 RIDGE LAKE RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9526
Practice Address - Country:US
Practice Address - Phone:850-682-7114
Practice Address - Fax:850-682-1662
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1741662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7671105Medicaid