Provider Demographics
NPI:1578048377
Name:CARROLL, TAYLOR B (APRN, CNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:B
Other - Last Name:RUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 E 1ST ST STE 212
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3175
Mailing Address - Country:US
Mailing Address - Phone:815-285-5843
Mailing Address - Fax:815-285-5846
Practice Address - Street 1:215 E 1ST ST STE 212
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3175
Practice Address - Country:US
Practice Address - Phone:815-285-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018245363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner