Healthcare Provider Details

I. General information

NPI: 1013597772
Provider Name (Legal Business Name): MS. CHARTESHIA T LEONARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SWEETGUM RD
EAST PALATKA FL
32131-4203
US

IV. Provider business mailing address

110 SWEETGUM RD
EAST PALATKA FL
32131-4203
US

V. Phone/Fax

Practice location:
  • Phone: 386-538-4620
  • Fax:
Mailing address:
  • Phone: 386-538-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5243094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: