Basic Information
| Provider Information | |||||||||
| NPI: | 1073803201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | TAICE | ||||||||
| MiddleName: | AEISHA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16926 SW 34TH STREET | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544324186 | ||||||||
| FaxNumber: | 9544324186 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 W OAKLAND PARK | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054458461 | ||||||||
| FaxNumber: | 3054416879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 9182188 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | G00QN | 01 | FL | BCBS | OTHER |