Healthcare Provider Details

I. General information

NPI: 1700549672
Provider Name (Legal Business Name): TAYLOR LEIGH BREZINKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR LEIGH NYLAND

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 02/20/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 300
MEMPHIS TN
38104-6655
US

IV. Provider business mailing address

1211 UNION AVE
MEMPHIS TN
38104-6638
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6018
  • Fax: 901-201-4203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5353
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: