MEDICARE: TASHA SAMANTHA LEONARD AGACNP

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	363L00000X	Nurse Practitioner	AP144214	TX
2	363LG0600X	Gerontology Nurse Practitioner	AP144214	TX

General Provider Information

NPI Number	:	1326664020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA SAMANTHA LEONARD AGACNP

Provider Business Mailing Address
First Line	:	6921 BRISBANE CT STE 220
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7094
Country	:	US
Telephone Number	:	281-980-1282
Fax Number	:	281-980-2321

Provider Business Practice Location Address
First Line	:	6921 BRISBANE CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7094
Country	:	US
Telephone Number	:	713-527-5354
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	03/01/2023

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