MEDICARE: GAYLINN BREEZE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	283578-4405	UT
2	363L00000X	Nurse Practitioner	283578-4405	UT

General Provider Information

NPI Number	:	1023412434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLINN BREEZE NP

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3723 W 12600 S STE 270
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7296
Country	:	US
Telephone Number	:	801-285-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	12/02/2025

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Directions to “ GAYLINN BREEZE NP” Practice Location

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