Provider Demographics
NPI:1063791382
Name:TAYLOR THOMAS, CARMALITA ANN (FNP PNP)
Entity type:Individual
Prefix:
First Name:CARMALITA
Middle Name:ANN
Last Name:TAYLOR THOMAS
Suffix:
Gender:F
Credentials:FNP PNP
Other - Prefix:MS
Other - First Name:CARMALITA
Other - Middle Name:ANN
Other - Last Name:TAYLOR THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTIONER
Mailing Address - Street 1:3300 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1500
Mailing Address - Country:US
Mailing Address - Phone:718-547-4071
Mailing Address - Fax:718-547-4099
Practice Address - Street 1:4626 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1610
Practice Address - Country:US
Practice Address - Phone:718-547-4071
Practice Address - Fax:718-547-4099
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38 382097261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)