Provider Demographics
NPI:1194418046
Name:LASSITER, TAYLOR MARIE (NP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LEAH CT
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1540
Mailing Address - Country:US
Mailing Address - Phone:615-636-3576
Mailing Address - Fax:
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD.
Practice Address - Street 2:SUITE 300 C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-284-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily