Provider Demographics
NPI:1457171357
Name:CARRAL, TAYLOR ASHLYN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLYN
Last Name:CARRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15242 WOODCREST RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8177
Mailing Address - Country:US
Mailing Address - Phone:352-232-4737
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DR STE 204
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6604
Practice Address - Country:US
Practice Address - Phone:727-791-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035928363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics