Provider Demographics
NPI:1356804736
Name:TAYLOR, LEVELDA DIANE (CNA)
Entity type:Individual
Prefix:
First Name:LEVELDA
Middle Name:DIANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:LEVELDA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4453 MELVIN CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4731
Mailing Address - Country:US
Mailing Address - Phone:904-365-3394
Mailing Address - Fax:
Practice Address - Street 1:4453 MELVIN CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4731
Practice Address - Country:US
Practice Address - Phone:904-365-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL204019376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide