Healthcare Provider Details

I. General information

NPI: 1649872334
Provider Name (Legal Business Name): PATRICK ST. LEGER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

IV. Provider business mailing address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1212
  • Fax: 352-371-4650
Mailing address:
  • Phone: 352-375-1212
  • Fax: 352-371-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9434475
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: