Healthcare Provider Details

I. General information

NPI: 1689767451
Provider Name (Legal Business Name): LEONA E. WESTBROOK-CHILCOTT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEONA E WESTBROOK-CHILCOTT CRNA

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FORT KEIS AVE
LABELLE FL
33935-6327
US

IV. Provider business mailing address

4200 FORT KEIS AVE
LABELLE FL
33935-6327
US

V. Phone/Fax

Practice location:
  • Phone: 863-514-9179
  • Fax:
Mailing address:
  • Phone: 863-675-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 1917122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: