Healthcare Provider Details

I. General information

NPI: 1366332686
Provider Name (Legal Business Name): TAYLER BREANNE ANDERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LEWIS SPEEDWAY UNIT 101
ST AUGUSTINE FL
32084-8669
US

IV. Provider business mailing address

351 E END RD
SAN MATEO FL
32187-2428
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-1863
  • Fax:
Mailing address:
  • Phone: 386-546-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA105878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: