| Doctor Name: | CARLY TAYLOR |
| NPI Number: | 1386022259 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 086017 |
| Business Practice Address: | 6 Fieldstone Cmns Suite D Tolland, CT - 060843419 |
| Business Phone Number: | 8608752099 |
| Business Fax Number: | 8608723021 |
| Mailing Address: | Po Box 3249, VERNON |
| State: | CT |
| Postal Code: | 060662149 |
| Phone Number: | 8608961422 |
| Fax Number: | 8608961425 |
| NPI Enumeration Date: | 05/12/2015 |
| NPI Last Update Date: | 05/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 086017 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |