Provider Demographics
NPI:1902410103
Name:VAN WARNER, TAYLOR L (AUD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:L
Last Name:VAN WARNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:L
Other - Last Name:TRAFICANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 4TH ST N # 116
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2322
Mailing Address - Country:US
Mailing Address - Phone:772-807-2154
Mailing Address - Fax:
Practice Address - Street 1:740 4TH ST N # 116
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2322
Practice Address - Country:US
Practice Address - Phone:772-807-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2359231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist