Provider Demographics
NPI:1508988098
Name:TAYLOR, LESLIE C (RN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 UVALDA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4574
Mailing Address - Country:US
Mailing Address - Phone:912-283-1359
Mailing Address - Fax:912-283-1360
Practice Address - Street 1:409 UVALDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4574
Practice Address - Country:US
Practice Address - Phone:912-283-1359
Practice Address - Fax:912-283-1360
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily