Provider Demographics
NPI:1588098891
Name:TAYLOR, TRACY JEAN (LPN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-4708
Mailing Address - Country:US
Mailing Address - Phone:864-576-1371
Mailing Address - Fax:864-595-2408
Practice Address - Street 1:375 SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-4708
Practice Address - Country:US
Practice Address - Phone:864-576-1371
Practice Address - Fax:864-595-2408
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP34673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse