Provider Demographics
NPI:1366171167
Name:TARAWALLY, TAYLOR RENEE (CAA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:TARAWALLY
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8872 STONE HARBOUR LOOP
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-6326
Mailing Address - Country:US
Mailing Address - Phone:417-298-9351
Mailing Address - Fax:
Practice Address - Street 1:5731 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5056
Practice Address - Country:US
Practice Address - Phone:941-342-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA1032367H00000X
MO367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant