Provider Demographics
NPI:1306053038
Name:TAYLOR SERAFINI, AMY MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:TAYLOR SERAFINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:4140 W 190TH ST STE 360W
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-453-1871
Mailing Address - Fax:310-453-3910
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 360W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-1871
Practice Address - Fax:310-453-3910
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14247363LA2200X
CA56950363LP2300X
CA566950363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care