Healthcare Provider Details

I. General information

NPI: 1407415540
Provider Name (Legal Business Name): CHRISTINE JEAN-LEON RN, ADMN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 OAKFIELD DR STE. 115A
BRANDON FL
33511-4930
US

IV. Provider business mailing address

1111 OAKFIELD DR STE. 115A
BRANDON FL
33511-4930
US

V. Phone/Fax

Practice location:
  • Phone: 813-774-3201
  • Fax: 813-774-3202
Mailing address:
  • Phone: 813-774-3201
  • Fax: 813-774-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9305114
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: