Healthcare Provider Details

I. General information

NPI: 1811881097
Provider Name (Legal Business Name): ISIS LEONARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 VILLA SAN JOSE DR
JACKSONVILLE FL
32217-4627
US

IV. Provider business mailing address

3914 VILLA SAN JOSE DR
JACKSONVILLE FL
32217-4627
US

V. Phone/Fax

Practice location:
  • Phone: 904-568-7538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: