Provider Demographics
NPI:1366019473
Name:TAYLOR, LENISA LIA (DNP)
Entity type:Individual
Prefix:
First Name:LENISA
Middle Name:LIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LENISA
Other - Middle Name:LIA
Other - Last Name:LEYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7822 N VIA LA HABRA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8110
Mailing Address - Country:US
Mailing Address - Phone:575-636-5887
Mailing Address - Fax:
Practice Address - Street 1:7822 N VIA LA HABRA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-8110
Practice Address - Country:US
Practice Address - Phone:575-636-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily