Provider Demographics
NPI:1215468558
Name:TAYLOR, CHARRA VANAE
Entity type:Individual
Prefix:MRS
First Name:CHARRA
Middle Name:VANAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 SEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476-1609
Mailing Address - Country:US
Mailing Address - Phone:352-396-4325
Mailing Address - Fax:
Practice Address - Street 1:8888 SEVILLE ST
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1609
Practice Address - Country:US
Practice Address - Phone:352-396-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities