Provider Demographics
NPI:1548854573
Name:TAYLOR, ANTOINETTE LASHON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:LASHON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 COLLETT AVE APT 1713
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3783
Mailing Address - Country:US
Mailing Address - Phone:661-449-7394
Mailing Address - Fax:
Practice Address - Street 1:11711 COLLETT AVE APT 1713
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3783
Practice Address - Country:US
Practice Address - Phone:661-449-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty