Provider Demographics
NPI:1669943890
Name:D'ETCHEVERRY, TAYLOR ERIN (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:ERIN
Last Name:D'ETCHEVERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:E
Other - Last Name:D'ETCHEVERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR STE 8600
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6005
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHAM DR STE 8600
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0110009282363A00000X
WV22682086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care