Provider Demographics
NPI:1720889850
Name:TAYLOR, VIRGINIA A
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:A
Other - Last Name:TAYLOR-GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123
Mailing Address - Country:US
Mailing Address - Phone:614-653-9043
Mailing Address - Fax:
Practice Address - Street 1:115 WOODLAND AVE APT 105
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:614-653-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH766728833747A0650X
OH27308893747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH76672883OtherOHIO ID
OH2730889Medicaid