Healthcare Provider Details

I. General information

NPI: 1720906647
Provider Name (Legal Business Name): LESLI HALL JESUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CONGRESS AVE STE 420
BOYNTON BEACH FL
33426-6588
US

IV. Provider business mailing address

811 W OAKLAND PARK BLVD APT F9
WILTON MANORS FL
33311-0901
US

V. Phone/Fax

Practice location:
  • Phone: 561-364-1479
  • Fax:
Mailing address:
  • Phone: 561-806-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9277260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: