Healthcare Provider Details

I. General information

NPI: 1699437905
Provider Name (Legal Business Name): NATALIE LEEDY PHD, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 1201
JACKSONVILLE FL
32258-5235
US

IV. Provider business mailing address

13241 BARTRAM PARK BLVD UNIT 209
JACKSONVILLE FL
32258-5233
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5437
  • Fax:
Mailing address:
  • Phone: 904-224-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY11888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: