Provider Demographics
NPI:1942838099
Name:TAYLOR, COLLEEN ELIZABETH (MD)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N RICHARD JACKSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2563
Mailing Address - Country:US
Mailing Address - Phone:850-636-7076
Mailing Address - Fax:
Practice Address - Street 1:140 N RICHARD JACKSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2563
Practice Address - Country:US
Practice Address - Phone:850-636-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR53852084P0800X
390200000X
KY594012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program