Provider Demographics
NPI:1215949953
Name:TAYLOR, CYNTHIA A (NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:TAYLOR
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:PO BOX 71267
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1267
Mailing Address - Country:US
Mailing Address - Phone:804-921-7299
Mailing Address - Fax:
Practice Address - Street 1:7300 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3735
Practice Address - Country:US
Practice Address - Phone:804-355-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00242164961363L00000X
VA0024164961363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172967OtherANTHEM
VAP00168231OtherMEDICARE RAILROAD
VA1215949953Medicaid
VA172967OtherHEALTHKEEPERS
VAP00168231OtherMEDICARE RAILROAD
VA020821H09Medicare PIN
VA172967OtherANTHEM