Healthcare Provider Details

I. General information

NPI: 1952369928
Provider Name (Legal Business Name): GARY L LEFFELMAN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 ARGYLE FOREST BLVD STE 2
JACKSONVILLE FL
32244-6601
US

IV. Provider business mailing address

6520 FORT CAROLINE RD
JACKSONVILLE FL
32277-2044
US

V. Phone/Fax

Practice location:
  • Phone: 904-777-6228
  • Fax: 904-777-6722
Mailing address:
  • Phone: 904-744-7300
  • Fax: 904-722-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2037292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: