Provider Demographics
NPI:1477264000
Name:TAYLOR, LESLIE (APRN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 MCGREGOR BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4488
Mailing Address - Country:US
Mailing Address - Phone:239-314-3223
Mailing Address - Fax:239-400-4240
Practice Address - Street 1:12651 MCGREGOR BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4488
Practice Address - Country:US
Practice Address - Phone:239-314-3223
Practice Address - Fax:239-400-4240
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021460363LP0808X
FL11021460363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health