Provider Demographics
NPI:1912940230
Name:TAYLOR, PEGGY SUE
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:TAYLOR
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 1:521 W STATE ROAD 434
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4984
Mailing Address - Country:US
Mailing Address - Phone:407-332-6611
Mailing Address - Fax:407-332-8512
Practice Address - Street 1:521 W STATE ROAD 434
Practice Address - Street 2:SUITE 204
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4984
Practice Address - Country:US
Practice Address - Phone:407-332-6611
Practice Address - Fax:407-332-8512
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP666192176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301973000 34Medicaid