Provider Demographics
NPI:1154342558
Name:TAYLOR, DE ANNA MARIE (MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DE ANNA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BOULEVARD
Mailing Address - Street 2:#175-90651
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:866-579-5103
Mailing Address - Fax:866-280-6661
Practice Address - Street 1:56612 KISMET RD
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-4372
Practice Address - Country:US
Practice Address - Phone:760-821-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3099232363LF0000X
TXAP 127168363LF0000X
TNAPN 19800363LF0000X
CA95007703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3832ZMedicare ID - Type Unspecified
FLK6782Medicare ID - Type Unspecified