Provider Demographics
NPI:1447815311
Name:TAYLOR, LACONYA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LACONYA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRICKSTON RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6402
Mailing Address - Country:US
Mailing Address - Phone:443-306-0476
Mailing Address - Fax:
Practice Address - Street 1:4140 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2254
Practice Address - Country:US
Practice Address - Phone:410-585-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182823363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care