Provider Demographics
NPI:1871196477
Name:AGATE, TAYLOR N (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:N
Last Name:AGATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:N
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:STE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-432-2300
Mailing Address - Fax:708-409-5179
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:STE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-432-2300
Practice Address - Fax:708-409-5179
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59283363A00000X
IL085009466363A00000X
IL085.009466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant