Provider Demographics
NPI:1083689905
Name:TAYLOR, CAROL C (PA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 WINDSOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5153
Mailing Address - Country:US
Mailing Address - Phone:423-883-9918
Mailing Address - Fax:
Practice Address - Street 1:3555 WINDSOR CIR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5153
Practice Address - Country:US
Practice Address - Phone:423-883-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPA9238OtherLICENSE
TN1052538OtherCERTIFICATION NUMBER
TN3670473Medicare ID - Type UnspecifiedMEDICARE PROVIDER #