Basic Information
| Provider Information | |||||||||
| NPI: | 1285042549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEMNICK | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | EDD, LAT, ATC, CES, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1745 S HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337561852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275870377 | ||||||||
| FaxNumber: | 7275481360 | ||||||||
| Practice Location | |||||||||
| Address1: | 8900 PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337774119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275454545 | ||||||||
| FaxNumber: | 7275481360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT1068 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | AL5456 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.