Healthcare Provider Details

I. General information

NPI: 1639568314
Provider Name (Legal Business Name): TINA A LEASURE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA RAMESHBHAI

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 DURANGO RD
DESTIN FL
32541-3073
US

IV. Provider business mailing address

173 DURANGO RD
DESTIN FL
32541-3073
US

V. Phone/Fax

Practice location:
  • Phone: 512-466-1223
  • Fax:
Mailing address:
  • Phone: 512-466-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1003336
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106240
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015690
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695188
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9339790
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number695188
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11015690
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10028991
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: