Healthcare Provider Details

I. General information

NPI: 1336061431
Provider Name (Legal Business Name): LESLIE ANN BAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 SERENO DR
DAVENPORT FL
33896-8602
US

IV. Provider business mailing address

1728 SERENO DR
DAVENPORT FL
33896-8602
US

V. Phone/Fax

Practice location:
  • Phone: 863-535-9051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN11049591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: