Provider Demographics
NPI:1174600670
Name:TAAFFE, CAROL (RN MSN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TAAFFE
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ACADEMY AVENUE
Mailing Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703
Mailing Address - Country:US
Mailing Address - Phone:757-483-6404
Mailing Address - Fax:757-483-0737
Practice Address - Street 1:3300 ACADEMY AVENUE
Practice Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-483-6404
Practice Address - Fax:757-483-0737
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001050835163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA057455OtherANTHEM
VA7709510Medicaid