Provider Demographics
NPI:1205292455
Name:JACKSON, TAYLOR BUCHANAN (FNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BUCHANAN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SAXON HILL DR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2905
Mailing Address - Country:US
Mailing Address - Phone:410-419-1438
Mailing Address - Fax:
Practice Address - Street 1:4510 EXECUTIVE DR STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3023
Practice Address - Country:US
Practice Address - Phone:858-657-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190900363LF0000X
CA95003121363LF0000X
NC5017962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily