Healthcare Provider Details

I. General information

NPI: 1962425546
Provider Name (Legal Business Name): LESLIE DAWN ROSENBERG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/25/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE.
JACKSONVILLE FL
32228
US

IV. Provider business mailing address

280 CHILD ST
JACKSONVILLE FL
32214-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4280
  • Fax: 904-270-4456
Mailing address:
  • Phone: 904-270-4280
  • Fax: 904-270-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP3004482
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3004480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: