Provider Demographics
NPI:1316639529
Name:TAYLOR, WESLEY RAY (APRN)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:RAY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 LANIER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-9355
Mailing Address - Country:US
Mailing Address - Phone:863-512-9263
Mailing Address - Fax:
Practice Address - Street 1:560 LANIER RD
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-9355
Practice Address - Country:US
Practice Address - Phone:863-581-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026565363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care