Provider Demographics
NPI:1396832440
Name:BREZNAY, LEIGH A (PA-C, MPAS)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:A
Last Name:BREZNAY
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 MONDAVI DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5188
Mailing Address - Country:US
Mailing Address - Phone:321-242-8790
Mailing Address - Fax:321-751-9362
Practice Address - Street 1:7125 MURRELL RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-242-8790
Practice Address - Fax:321-751-9362
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2496363A00000X
FLPAX00007028363A00000X
FLPA9104148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9104148OtherSTATE LICENSE NUMBER
OH2496OtherSTATE LICENSE NUMBER
FL7028OtherPRESCRIBING LICENSE