Healthcare Provider Details

I. General information

NPI: 1932594462
Provider Name (Legal Business Name): LESLIE CASIPLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ROSS CLARK CIR
DOTHAN AL
36301-3022
US

IV. Provider business mailing address

128 JENKS CIR
PANAMA CITY FL
32405-4319
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-8111
  • Fax:
Mailing address:
  • Phone: 850-522-8165
  • Fax: 850-522-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: