Provider Demographics
NPI:1427683911
Name:TAYLOR, ANDREA AISHA (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:AISHA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 OLDE TOWNE RUN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-5016
Mailing Address - Country:US
Mailing Address - Phone:757-358-1199
Mailing Address - Fax:
Practice Address - Street 1:2613 TAYLOR RD STE 201
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2246
Practice Address - Country:US
Practice Address - Phone:757-738-1600
Practice Address - Fax:757-465-8616
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily