Provider Demographics
NPI:1043873987
Name:TZEN, LESLIE BROOK (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BROOK
Last Name:TZEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:BROOK
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 GENERAL STEWART WAY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2422
Mailing Address - Country:US
Mailing Address - Phone:912-332-4525
Mailing Address - Fax:
Practice Address - Street 1:141 S MACON ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1114
Practice Address - Country:US
Practice Address - Phone:912-427-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily