Provider Demographics
NPI:1083197107
Name:TAYLOR, JESSICA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6656 DOBBIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5841
Mailing Address - Country:US
Mailing Address - Phone:410-381-1330
Mailing Address - Fax:
Practice Address - Street 1:6656 DOBBIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5841
Practice Address - Country:US
Practice Address - Phone:410-381-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006704363A00000X
GA9475363A00000X
MDC06942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110-006704OtherVIRGINIA BOARD OF MEDICINE
GA9475OtherGEORGIA COMPOSITE MEDICAL BOARD
MDC06942OtherMARYLAND BOARD OF PHYSICIANS