Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Angenette Shane Taylor, CNP

Individual provider Gerontology Nurse Practitioner · NPI 1760081871

Angenette Shane Taylor, CNP is a Nurse Practitioner in Dallas, Texas. Qualified in 2020, 6 years ago. Practices with Northside Cardiovascular Professional Services, LLC, a 142-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia and Michigan.

Years since qualifying
6
Licensed in
GA, MI
In the registry since
2020
Specialties on file
3
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

4055 Valley View Ln Ste 700
Dallas, TX 75244-5045
Phone: (972) 715-3800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 — (678) 312-3294

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 4704250947 (MI)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence 4704250947 (MI)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence RN156114 (GA)

Record details

NPI number1760081871
Entity typeIndividual (Type 1)
GenderFemale
Credentials CNP
Sole proprietorNo
NPI enumeratedOctober 20, 2020
Last updated in NPPESOctober 17, 2024
Certification dateOctober 17, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Northside Cardiovascular Professional Services, Llc — 142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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