Provider Demographics
NPI:1114675030
Name:BARGELOH, TAYLOR LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LOUISE
Last Name:BARGELOH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LOUISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:434 STONEBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9854
Mailing Address - Country:US
Mailing Address - Phone:309-262-0899
Mailing Address - Fax:
Practice Address - Street 1:2321 POOLER PKWY STE 107
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4423
Practice Address - Country:US
Practice Address - Phone:912-303-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA11721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant