Provider Demographics
NPI:1104330018
Name:POLING, TAYLOR
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:POLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8343 PRINCETON SQUARE BLVD E APT 1312
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8384
Mailing Address - Country:US
Mailing Address - Phone:704-578-5288
Mailing Address - Fax:
Practice Address - Street 1:8343 PRINCETON SQUARE BLVD E APT 1312
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8384
Practice Address - Country:US
Practice Address - Phone:704-578-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator