Individual provider Active NPI

Taylor Marie Banaszak, PA-C

  • Physician Assistant
  • Winter Haven, FL
National Provider Identifier
1679341754
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9118109 Issued in FL
Practice address
550 Pope Ave NW
Winter Haven, FL 33881-4679
Phone
(863) 299-2630
Fax
(863) 904-0398
NPI assigned
Dec 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 030381 NY
Physician Assistant 363A00000X PA9118109 FL Primary

Addresses

Primary practice location

550 Pope Ave NW
Winter Haven, FL 33881-4679

Mailing address

425 W Colonial Dr Ste 303
Orlando, FL 32804-6863
Phone (321) 332-6947

Other practice location 1

3240 S Florida Ave Ste 101
Lakeland, FL 33803-4574
Phone (863) 644-7337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116002474 FL Practitioner - Physician Assistant 2961854930 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovacare Florida Urgent Care, LLCGroup PAC ID 1557802840, 20 clinicians

Practice addresses (Care Compare)

10222 Bloomingdale Ave
Riverview, FL 33578-3659
Phone (813) 515-5814

1037 S State Rd
7 Suite 113
Wellington, FL 33414-6139
Phone (561) 798-3030

1127 Bruce B Downs Blvd
Wesley Chapel, FL 33544-9208
Phone (813) 536-1865

11826 State Rd
Suite 54
Odessa, FL 33556-3496
Phone (813) 616-8001

3240 S Florida Ave
Suite 101
Lakeland, FL 33803-4574
Phone (863) 644-7337

440 W Hwy 436
Adventhealth Centra Care Altamonte
Altamonte Springs, FL 32714-4136
Phone (407) 788-2000

550 Pope Ave NW
Suite 200
Winter Haven, FL 33881-4679
Phone (863) 299-2630

6930 Gunn Hwy
Tampa, FL 33625-3853
Phone (813) 543-0800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9118109FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Dec 22, 2025 Accepting new patients
Adventist Health System/Sunbelt, Inc. Physician Assistant CurrentSince Dec 22, 2025 Accepting new patients

Locations

440 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 788-2000

Interoperability endpoints

  • Direct secure messaging: taylor.banaszak.1@27472.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1679341754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W COLONIAL DR STE 303",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046863",
            "telephone_number": "321-332-6947",
            "fax_number": "407-286-4515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 POPE AVE NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814679",
            "telephone_number": "863-299-2630",
            "fax_number": "863-904-0398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3240 S Florida Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338034574",
            "country_code": "US",
            "telephone_number": "863-644-7337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANASZAK",
        "first_name": "TAYLOR",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-18",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030381",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.