Healthcare Provider Details

I. General information

NPI: 1750982856
Provider Name (Legal Business Name): HANDERSON LEON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax:
Mailing address:
  • Phone: 407-303-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11046381
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11046381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: