Individual
AYZIA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
40 BALDWIN AVE, LUGOFF, SC 29078-9406
(803) 408-3262
Mailing address
40 BALDWIN AVE, LUGOFF, SC 29078-9406
(803) 408-3262
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
20601
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20601
SC LLR NURSING LICENSE NUMBER
SC
Enumeration date
12/19/2016
Last updated
12/19/2016
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