1710658042 NPI number — MS. TAYLER ROBIN EBERT APRN. FNP-C

Table of content: MS. TAYLER ROBIN EBERT APRN. FNP-C (NPI 1710658042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710658042 NPI number — MS. TAYLER ROBIN EBERT APRN. FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBERT
Provider First Name:
TAYLER
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN. FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGEE
Provider Other First Name:
TAYLER
Provider Other Middle Name:
ROBIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710658042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31603-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-548-3919
Provider Business Mailing Address Fax Number:
229-242-6087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4274 N VALDOSTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31602-6814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-242-1234
Provider Business Practice Location Address Fax Number:
229-242-0687
Provider Enumeration Date:
09/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN215464 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN215464 . This is a "GEORGIA BOARD OF NURSE APRN LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: F08211302 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com